TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) DAVID J FELICIO ESQUIRE...................................................................... SECRETARY	0.25 ................. 40.75		X				0	1,077,100	208,192
(2) KYLE C SNYDER MHA...................................................................... CAO, DIRECTOR	40.00 ................. 0.75	X	X				472,255	0	77,805
(3) LENKE ERKI MD...................................................................... DIRECTOR	0.25 ................. 40.25	X					0	489,490	41,388
(4) JOSEPH A TORCHIA MD...................................................................... CMO, HSHS	40.00 ................. 0.00			X			495,339	0	11,142
(5) CHINH N PHAM MD...................................................................... DIRECTOR	0.25 ................. 40.25	X					0	424,225	43,863
(6) THOMAS J GRIFONE MD...................................................................... FORMER 5 HIGHEST	0.00 ................. 40.00					X	0	380,501	43,697
(7) MICHAEL J PASZEK MD...................................................................... FORMER 5 HIGHEST	0.00 ................. 40.00					X	0	351,516	37,228
(8) JASON STANFORD PHD RTR T CMD...................................................................... FORMER 5 HIGHEST	0.00 ................. 40.00					X	0	300,013	52,024
(9) RANDY B MORRIS...................................................................... TREASURER	40.00 ................. 0.75		X				313,189	0	35,470
(10) AJAY K SAINI MD...................................................................... DIRECTOR	0.25 ................. 40.25	X					0	299,432	42,405
(11) LORI R GRAMLEY ESQUIRE...................................................................... ASST. SECRETARY	0.25 ................. 40.75		X				0	304,113	30,799
(12) PAUL D BRETTSCHNEIDER MD...................................................................... FORMER 5 HIGHEST	0.00 ................. 40.00					X	0	278,722	41,008
(13) RICHARD SCHREIBER...................................................................... ASSOCIATE CIO	40.00 ................. 0.00				X		274,275	0	35,990
(14) DANIEL E LOHR ESQUIRE...................................................................... FORMER OFFICER	0.00 ................. 40.00					X	0	287,662	20,511
(15) ANDREW R WALKER MD...................................................................... FORMER 5 HIGHEST	0.00 ................. 40.00					X	0	264,430	37,995
(16) GLORIA SANTOS...................................................................... VP, CNO	40.00 ................. 0.00			X			272,143	0	29,698
(17) JAGADEESH K MOOLA MD...................................................................... FORMER 5 HIGHEST	0.00 ................. 40.00					X	0	256,928	40,338

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) BARBARA SUMBATIAN MD........................................................................ FORMER 5 HIGHEST	0.00 .......................40.00				X	0	249,626	34,628
(19) ELLEN R LENKEVICH CRNP........................................................................ VP, CHIEF NURSING OFFICER HSHS	40.00 .......................0.00			X		249,855	0	24,276
(20) COURTNEY K BAKER DO........................................................................ FORMER 5 HIGHEST	0.00 .......................40.00				X	0	206,341	9,673
(21) GERALD R NEWHOUSE........................................................................ FORMER KEY EMPLOYEE	0.00 .......................40.00				X	0	209,223	260
(22) JAMES A WILKEMEYER........................................................................ CLINICAL PHARMACIST	40.00 .......................0.00			X		174,906	0	17,965
(23) MARK E PAINTER........................................................................ SR. ADMIN DIRECTOR	40.00 .......................0.00			X		168,787	0	19,246
(24) BETH A THOMSON........................................................................ ASST. DIRECTOR, PHARM	40.00 .......................0.00			X		160,387	0	9,673
(25) RON DRNEVICH........................................................................ CHAIR, DIRECTOR	0.25 .......................0.50	X	X			0	0	0
(26) LAURIE SALTZGIVER ESQUIRE........................................................................ VICE CHAIR, DIRECTOR	0.25 .......................0.50	X	X			0	0	0
(27) CHRISTOPHER MOYER DO........................................................................ DIRECTOR	0.25 .......................0.50	X				0	0	0
(28) DEBORAH KEYS........................................................................ DIRECTOR	0.25 .......................0.50	X				0	0	0
(29) HANK STRAUB........................................................................ DIRECTOR	0.25 .......................0.50	X				0	0	0
(30) NORA HABIG........................................................................ DIRECTOR	0.25 .......................0.50	X				0	0	0
(31) REVEREND DAVID DANNEKER........................................................................ DIRECTOR	0.25 .......................0.50	X				0	0	0
(32) REVEREND ROBERT F SHARMAN........................................................................ DIRECTOR	0.25 .......................0.50	X				0	0	0
(33) SISTER JOANN MARIE AUMAND SCC........................................................................ DIRECTOR	0.25 .......................0.50	X				0	0	0
(34) SISTER MARIE PAULINE DEMEK SCC........................................................................ DIRECTOR	0.25 .......................0.50	X				0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
SODEXO INC, 9801 WASHINGTONIAN BLVD GAITHERSBURG,MD20878	DIETARY ETC	9,227,430
MEDEFIS CONSOLIDATED, 2121 N 117TH AVE OMAHA,NE68164	CONTRA AGENCY	3,968,844
WEST SHORE ANESTHESIA ASSOC, PO BOX 1050 CAMP HILL,PA17011	C ANESTHESIOLOGY	1,959,911
QUANTUM IMAGING, 629D LOWTHER RD LEWISBERRY,PA17339	IMAGING SERVICE	1,330,406
RESTORIX HEALTH, 445 HAMILTON AVENUE SUITE 800 WHITE PLAINS,NY10601	MEDICAL SERVICES	1,288,517
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 35

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

Attach to Form 990 or Form 990-EZ.
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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

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

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

Section A. Public Support

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

Section B. Total Support

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

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

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

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

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

Section A. Public Support

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

Section B. Total Support

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

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

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

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

Section A. All Supporting Organizations

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

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

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2019

Name of the organization

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

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

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

Name of organization HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY

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

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

Page 3

Name of organization HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY		Employer identification number 23-1512747

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

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

Page 4


Name of organization HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY			Employer identification number 23-1512747
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2019

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

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

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

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

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

(a)

Yes|No

(b)

Amount

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

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

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

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

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

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

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

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

Yes

1,473

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

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

Yes

3,002

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

4,475

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1	AMOUNT REPORTED ON LINE 1G REPRESENTS THE WAGES AND BENEFITS OF EMPLOYEES WHO ASSIST THE GOVERNMENT RELATIONS DEPARTMENT OF THE ORGANIZATION'S AFFILIATE, GEISINGER SYSTEM SERVICES. THE PRIMARY PURPOSE OF THE GOVERNMENT RELATIONS DEPARTMENT IS TO MAINTAIN CONTACT WITH FEDERAL, STATE, AND LOCAL GOVERNMENT OFFICIALS. THE DEPARTMENT PROMOTES LEGISLATIVE ACTIONS WITH RESPECT TO HEALTHCARE RELATED ISSUES THAT COULD IMPACT THE ORGANIZATION AND ITS AFFILIATES. OTHER LOBBYING ACTIVITIES REPORTED ON LINE 1I REPRESENTS THE PORTION OF MEMBERSHIP DUES, PAID BY THE ORGANIZATION TO TRADE OR PROFESSIONAL ASSOCIATIONS, ATTRIBUTABLE TO LOBBYING ACTIVITIES.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1

AMOUNT REPORTED ON LINE 1G REPRESENTS THE WAGES AND BENEFITS OF EMPLOYEES WHO ASSIST THE GOVERNMENT RELATIONS DEPARTMENT OF THE ORGANIZATION'S AFFILIATE, GEISINGER SYSTEM SERVICES. THE PRIMARY PURPOSE OF THE GOVERNMENT RELATIONS DEPARTMENT IS TO MAINTAIN CONTACT WITH FEDERAL, STATE, AND LOCAL GOVERNMENT OFFICIALS. THE DEPARTMENT PROMOTES LEGISLATIVE ACTIONS WITH RESPECT TO HEALTHCARE RELATED ISSUES THAT COULD IMPACT THE ORGANIZATION AND ITS AFFILIATES. OTHER LOBBYING ACTIVITIES REPORTED ON LINE 1I REPRESENTS THE PORTION OF MEMBERSHIP DUES, PAID BY THE ORGANIZATION TO TRADE OR PROFESSIONAL ASSOCIATIONS, ATTRIBUTABLE TO LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

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 ....	376,968,866	373,733,399	367,695,505	107,084,811	2,821,921
b	Contributions ...	290,000	2,213,000	954,000	253,720,000	109,799,000
c	Net investment earnings, gains, and losses	241,380	4,955,467	8,736,894	10,710,694	-2,060,358
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	4,114,000	3,933,000	3,653,000	3,820,000	3,474,000
f	Administrative expenses ....					1,752
g	End of year balance ......	373,386,246	376,968,866	373,733,399	367,695,505	107,084,811

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

Board designated or quasi-endowment SchDMd Bullet

74.920 %

Permanent endowment SchDMd Bullet

3.380 %

Term endowment SchDMd Bullet

21.700 %

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)

Yes

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

Yes

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 ....	11,662,683	1,807,866	9,854,817
c	Leasehold improvements
d	Equipment ....	34,026,659	23,345,107	10,681,552
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				20,536,369

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
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	62,779,985
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 2, PART V, LINE 4

ENDOWMENT FUNDS ARE USED BY GEISINGER TO SUPPORT PATIENT CARE, RESEARCH, EDUCATION, AND CAPITAL AND PROGRAM EXPENSES. THE 373,386,246 REPORTED ON LINE 1G, COLUMN A, REPRESENTS THE TOTAL ENDOWMENTS HELD BY GEISINGER HEALTH ON BEHALF OF ALL ITS AFFILIATED ORGANIZATIONS. OF THAT AMOUNT 3,633,000 IS HELD ON BEHALF OF HOLY SPIRIT HOSPITAL. THE 2014 REPORTING PERIOD WAS THE FIRST REPORTING PERIOD DURING WHICH GEISINGER HEALTH HELD ENDOWMENTS ON BEHALF OF HOLY SPIRIT HOSPITAL.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other 30000.0000000000 %

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

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

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	4,446,792		4,446,792	1.500 %
b	Medicaid (from Worksheet 3, column a) . . . . .	42,372,634	22,026,199	20,346,435	6.870 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	46,819,426	22,026,199	24,793,227	8.370 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	324,447		324,447	0.110 %
f	Health professions education (from Worksheet 5) . . .	766,587	113,592	652,995	0.220 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	1,091,034	113,592	977,442	0.330 %
k	Total. Add lines 7d and 7j .	47,910,460	22,139,791	25,770,669	8.700 %

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

Schedule H (Form 990) 2019

Page

Part II

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

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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

9,008,197

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

1,261,870

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

Section B. Medicare

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

45,836,049

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

69,486,459

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

-23,650,410

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 GRANDVIEW SURGERY CT	MEDICAL SERVICES	42.000 %	58.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY 503 NORTH 21ST STREET CAMP HILL,PA17011 WWW.GEISINGER.ORG 340801	X	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	HOLY SPIRIT HOSPITAL
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

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

Yes

6 a

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

Yes

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

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

Yes

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

Hospital facility’s website (list url): WWW.GEISINGER.ORG

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

If "Yes" (list url): WWW.GEISINGER.EDU

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	HOLY SPIRIT HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.000000000000%
and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

WWW.GEISINGER.ORG; SEE SEC C, PART V, Q16

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

SAME AS 16A ABOVE

A plain language summary of the FAP was widely available on a website (list url):
SAME AS 16A ABOVE

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	HOLY SPIRIT HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	HOLY SPIRIT HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
HOLY SPIRIT HOSPITAL	PART V, SECTION B, LINE 5: COMMUNITY HEALTH NEEDS ASSESSMENT, LINES 3, 5 AND 6A:A COLLABORATIVE APPROACH TO COMMUNITY HEALTH IMPROVEMENTTHE GEISINGER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL. THE STUDY AREA INCLUDED 19 COUNTIES ACROSS CENTRAL, NORTHEASTERN, AND SOUTH CENTRAL PENNSYLVANIA WHICH REPRESENT THE COLLECTIVE SERVICE AREAS OF THE COLLABORATING HOSPITALS. TO DISTINGUISH UNIQUE SERVICE AREAS AMONG HOSPITALS AND FOSTER COOPERATION WITH LOCAL COMMUNITY PARTNERS TO IMPACT HEALTH NEEDS, REGIONAL RESEARCH AND LOCAL REPORTING WAS DEVELOPED. THE COLLABORATING HEALTH SYSTEMS AGREED THAT BY COORDINATING EFFORTS TO IDENTIFY COMMUNITY HEALTH NEEDS ACROSS THE REGION, THE HEALTH SYSTEMS WOULD CONSERVE COMMUNITY RESOURCES WHILE DEMONSTRATING LEADERSHIP IN CONVENING LOCAL COMMUNITY PARTNERS TO ADDRESS COMMON PRIORITY NEEDS. BEST PRACTICES IN COMMUNITY HEALTH IMPROVEMENT DEMONSTRATE THAT FOSTERING "COLLECTIVE IMPACT" IS AMONG THE MOST SUCCESSFUL WAYS TO AFFECT THE HEALTH OF A COMMUNITY. COLLECTIVE IMPACT IS ACHIEVED BY COMMITTING A DIVERSE GROUP OF STAKEHOLDERS TOWARD A COMMON GOAL OR ACTION, PARTICULARLY TO IMPACT DEEP ROOTED SOCIAL OR HEALTH NEEDS. BY TAKING A COLLABORATIVE APPROACH TO THE CHNA, GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL ARE LEADING THE WAY TO IMPROVE THE HEALTH OF COMMUNITIES IN CENTRAL, NORTHEASTERN, AND SOUTH CENTRAL PENNSYLVANIA.CHNA LEADERSHIPTHE CHNA WAS OVERSEEN BY A PLANNING COMMITTEE OF REPRESENTATIVES FROM EACH HEALTH SYSTEM, AS WELL AS A REGIONAL ADVISORY COMMITTEE OF REPRESENTATIVES FROM EACH HOSPITAL.COMMUNITY ENGAGEMENTCOMMUNITY ENGAGEMENT WAS AN INTEGRAL PART OF THE CHNA. WEBINARS WERE HELD IN OCTOBER AND NOVEMBER 2017 TO ANNOUNCE THE ONSET OF THE CHNA AND ENCOURAGE BROAD PARTICIPATION ACROSS THE REGION. THROUGHOUT OCTOBER AND NOVEMBER 2017, A KEY INFORMANT SURVEY WAS SENT TO APPROXIMATELY 1,000 REPRESENTATIVES OF HEALTH AND HUMAN SERVICE ORGANIZATIONS, RELIGIOUS INSTITUTIONS, CIVIC ASSOCIATIONS, BUSINESSES, ELECTED OFFICIALS AND OTHER COMMUNITY REPRESENTATIVES. PARTNER FORUMS WERE HELD THROUGHOUT THE REGION IN JANUARY 2018 TO BRING TOGETHER THESE PARTNERS TO REVIEW RESEARCH FINDINGS AND PROVIDE FEEDBACK ON THE MOST PRESSING COMMUNITY HEALTH NEEDS. IN MARCH AND APRIL 2018, FOCUS GROUPS WITH SENIORS WERE HELD TO BETTER UNDERSTAND CHALLENGES AND OPPORTUNITIES TO IMPROVING HEALTH AMONG HIGH RISK POPULATIONS. COMMUNITY FORUMS WERE HELD IN FALL 2018 TO PRESENT CHNA FINDINGS AND IMPLEMENTATION PLANS TO COMMUNITY RESIDENTS AND PROVIDE A FORUM FOR DIALOGUE ABOUT ADDRESSING COMMUNITY HEALTH NEEDS.CHNA METHODOLOGYTHE CHNA WAS CONDUCTED FROM SEPTEMBER 2017 TO APRIL 2018 AND USED BOTH PRIMARY AND SECONDARY RESEARCH TO ILLUSTRATE AND COMPARE HEALTH TRENDS AND DISPARITIES ACROSS THE REGION. PRIMARY RESEARCH WAS USED TO SOLICIT INPUT FROM KEY COMMUNITY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. FOCUS GROUPS AND INTERVIEWS WERE USED TO COLLECT IN-DEPTH INSIGHT FROM HEALTH CONSUMERS REPRESENTING MEDICALLY UNDERSERVED OR HIGH RISK POPULATIONS. EXISTING DATA SOURCES, INCLUDING PUBLIC HEALTH STATISTICS, DEMOGRAPHIC AND SOCIAL MEASURES, AND HEALTHCARE UTILIZATION, WERE COLLECTED AND ANALYZED TO IDENTIFY HEALTH TRENDS ACROSS HOSPITAL SERVICE AREAS. SPECIFIC RESEARCH METHODS INCLUDED: -AN ANALYSIS OF STATISTICAL HEALTH AND SOCIOECONOMIC INDICATORS FROM ACROSS THE REGION -AN ANALYSIS AND COMPARISON OF ACUTE HOSPITAL UTILIZATION DATA -A KEY INFORMANT SURVEY WITH 113 COMMUNITY LEADERS AND REPRESENTATIVES -SIX REGIONAL PARTNER FORUMS WITH COMMUNITY BASED ORGANIZATIONS TO IDENTIFY COMMUNITY HEALTH PRIORITIES AND FACILITATE COLLABORATION TOWARD COMMUNITY HEALTH IMPROVEMENT-TWELVE FOCUS GROUPS WITH SENIORS TO EXAMINE PREFERENCES, CHALLENGES, AND OPPORTUNITIES TO ACCESSING AND RECEIVING HEALTHCARE -PRIORITIZATION OF COMMUNITY HEALTH NEEDS TO DETERMINE THE MOST PRESSING HEALTH ISSUES ON WHICH TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTSTHE CHNA BUILT UPON THE HOSPITALS' PREVIOUS CHNAS AND SUBSEQUENT IMPLEMENTATION PLANS. THE RESEARCH FINDINGS WILL BE USED TO GUIDE COMMUNITY BENEFIT INITIATIVES FOR THE HOSPITALS AND ENGAGE LOCAL PARTNERS TO COLLECTIVELY ADDRESS IDENTIFIED HEALTH NEEDS.PRIORITIZED COMMUNITY HEALTH NEEDSIN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY, GEISINGER AND ITS CHNA PARTNERS SOLICITED AND RECEIVED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY EACH HOSPITAL, INCLUDING THOSE WITH EXPERTISE IN PUBLIC HEALTH, REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND OTHER COMMUNITY STAKEHOLDERS WHO BROUGHT WIDE PERSPECTIVES ON COMMUNITY HEALTH NEEDS, EXISTING COMMUNITY RESOURCES TO MEET THOSE NEEDS, AND GAPS IN THE CURRENT SERVICE DELIVERY SYSTEM. THROUGH FACILITATED DIALOGUE AND A SERIES OF CRITERIA-BASED VOTING EXERCISES, THE FOLLOWING HEALTH ISSUES WERE PRIORITIZED AS THE MOST SIGNIFICANT HEALTH NEEDS ACROSS THE REGION ON WHICH TO FOCUS HEALTH IMPROVEMENT EFFORTS OVER THE COMING THREE-YEAR CYCLE.-ACCESS TO CARE-BEHAVIORAL HEALTH (TO INCLUDE SUBSTANCE ABUSE AND MENTAL HEALTH STRATEGIES)-CHRONIC DISEASE PREVENTION AND MANAGEMENT (WITH A FOCUS ON INCREASING HEALTHY HABITS)TO DIRECT COMMUNITY BENEFIT AND HEALTH IMPROVEMENT ACTIVITIES, GEISINGER AND ITS CHNA PARTNERS CREATED INDIVIDUAL IMPLEMENTATION PLANS FOR EACH HOSPITAL TO DETAIL THE RESOURCES AND SERVICES THAT WILL BE USED TO ADDRESS THESE IDENTIFIED HEALTH PRIORITIES.BOARD APPROVALTHE GEISINGER CHNA FINAL REPORTS WERE REVIEWED AND APPROVED BY THE GEISINGER HEALTH AFFILIATE BOARDS ON JUNE 20, 2018 AND THE GEISINGER HEALTH BOARD OF DIRECTORS ON JUNE 21, 2018. FOLLOWING THE BOARDS' APPROVAL, ALL CHNA REPORTS WERE MADE AVAILABLE TO THE PUBLIC VIA THE GEISINGER WEBSITE AT HTTPS://WWW.GEISINGER.ORG/ABOUT-GEISINGER/COMMUNITY-ENGAGEMENT/CHNA. RESEARCH PARTNER BAKER TILLY WAS ENGAGED AS OUR CHNA RESEARCH PARTNER. BAKER TILLY ASSISTED IN ALL PHASES OF THE CHNA INCLUDING PROJECT MANAGEMENT, QUANTITATIVE AND QUALITATIVE DATA COLLECTION, SMALL AND LARGE GROUP FACILITATION AND REPORT WRITING. THE BAKER TILLY TEAM HAS WORKED WITH MORE THAN 100 HOSPITALS AND THOUSANDS OF THEIR COMMUNITY PARTNERS ACROSS THE NATION TO ASSESS HEALTH NEEDS AND DEVELOP ACTIONABLE PLANS FOR COMMUNITY HEALTH IMPROVEMENT.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.
HOLY SPIRIT HOSPITAL	PART V, SECTION B, LINE 6A: ALLIED SERVICES REHABILITATION HOSPITAL, JOHN HEINZ REHABILITATION HOSPITAL, EVANGELICAL COMMUNITY HOSPITAL, GEISINGER MEDICAL CENTER (INCLUDES GEISINGER-SHAMOKIN AREA COMMUNITY HOSPITAL), GEISINGER ENCOMPASS HEALTH LIMITED LIABILITY COMPANY (DBA GEISINGER ENCOMPASS HEALTH REHABILITATION HOSPITAL), GEISINGER WYOMING VALLEY MEDICAL CENTER (INCLUDES GEISINGER SOUTH WILKES-BARRE), GEISINGER-BLOOMSBURG HOSPITAL, COMMUNITY MEDICAL CENTER (DBA GEISINGER COMMUNITY MEDICAL CENTER), GEISINGER JERSEY SHORE HOSPITAL, GEISINGER-LEWISTOWN HOSPITAL, AND HOLY SPIRIT HOSPITAL (DBA GEISINGER HOLY SPIRIT).
HOLY SPIRIT HOSPITAL	PART V, SECTION B, LINE 11: FIVE PRIORITY AREAS WERE IDENTIFIED WITHIN OUR CURRENT CHNA: ACCESS TO CARE, BEHAVIORAL HEALTH, CHRONIC DISEASE, MATERNAL/INFANT HEALTH, AND SENIOR HEALTH. IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY, GEISINGER AND ITS CHNA PARTNERS SOLICITED AND RECEIVED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY EACH HOSPITAL, INCLUDING THOSE WITH EXPERTISE IN PUBLIC HEALTH, REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND OTHER COMMUNITY STAKEHOLDERS WHO BROUGHT WIDE PERSPECTIVES ON COMMUNITY HEALTH NEEDS, EXISTING COMMUNITY RESOURCES TO MEET THOSE NEEDS, AND GAPS IN THE CURRENT SERVICE DELIVERY SYSTEM. THROUGH FACILITATED DIALOGUE AND A SERIES OF CRITERIA-BASED VOTING EXERCISES, THE FOLLOWING HEALTH ISSUES WERE PRIORITIZED AS THE MOST SIGNIFICANT HEALTH NEEDS ACROSS THE REGION ON WHICH TO FOCUS HEALTH IMPROVEMENT EFFORTS OVER THE COMING THREE-YEAR CYCLE: ACCESS TO CARE, BEHAVIORAL HEALTH, AND CHRONIC DISEASE. PROGRAMMING AND CLINICAL SERVICES WITHIN THESE PRIORITY AREAS IMPACT THE POPULATIONS OF MATERNAL/INFANT HEALTH AND SENIOR HEALTH AND ARE THEREBY SERVED THROUGH ALL APPROPRIATE HEALTH IMPROVEMENT EFFORTS.BELOW ARE SYSTEMWIDE PROGRAMS OFFERED BY GEISINGER TO FULFILL COMMUNITY NEEDS THAT WERE IDENTIFIED IN THE HOSPITAL'S MOST RECENT CHNA. SOME PROGRAMS ARE COMPLETELY OPERATED OR FUNDED BY GEISINGER AND SOME ARE OFFERED IN COOPERATION WITH LOCAL HEALTH AND HUMAN SERVICE AGENCIES. FOR MORE SPECIFIC NEEDS FOUND IN OUR LOCAL COMMUNITIES, WE OFFER PROGRAMS TO SERVE PATIENTS CLOSE TO HOME. THE TOP THREE NEEDS IDENTIFIED IN THE MOST RECENT AND/OR PAST CHNA SURVEYS FALL INTO ONE OF THREE COMMUNITY NEED CATEGORIES:1)IMPROVING ACCESS TO HEALTHCARE: THE MOST SIGNIFICANT NEED IDENTIFIED WAS FOR BETTER, FASTER, MORE CONVENIENT AND LESS COSTLY ACCESS TO HEALTHCARE SERVICES. GEISINGER IS TAKING INNOVATIVE STEPS TO ADDRESS BARRIERS TO HEALTHCARE BY: INCREASING THE NUMBER OF RESIDENTS WHO HAVE A REGULAR PRIMARY CARE PROVIDER, INCREASING ACCESS TO PRIMARY AND SPECIALTY CARE PROVIDERS, REDUCING BARRIERS TO RECEIVING CARE FOR RESIDENTS WITHOUT TRANSPORTATION, PROMOTING AWARENESS OF AVAILABLE OPTIONS FOR ASSISTANCE TO PAY FOR HEALTHCARE NEEDS AND FOSTERING THE PURSUIT OF HEALTH CAREERS AND ONGOING TRAINING OF HEALTH PROFESSIONALS.2)ADDRESSING BEHAVIORAL HEALTH AND SUBSTANCE ABUSE: GEISINGER IS COMMITTED TO HELPING PATIENTS FIND HEALTHCARE SERVICES WHEN THEY ARE FACING BEHAVIORAL HEALTH CHALLENGES OR STRUGGLING WITH ADDICTION. WE ADVANCE DIALOGUE AT THE LOCAL AND STATE LEVEL TO ADDRESS BEHAVIORAL HEALTH NEEDS. WE FOSTER INTEGRATION OF BEHAVIOR AND PRIMARY HEALTH CARE. WE PROVIDE EDUCATION TO INCREASE RESIDENTS' AWARENESS OF BEHAVIORAL HEALTH ISSUES AND REDUCE THE STIGMA ASSOCIATED WITH BEHAVIORAL HEALTH CONDITIONS. AND WE STRIVE TO INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES.3)MANAGING CHRONIC CONDITIONS: GEISINGER HAS NUMEROUS PROGRAMS TO HELP PATIENTS PREVENT AND MANAGE CHRONIC CONDITIONS. EFFORTS INCLUDE ENCOURAGING COMMUNITY INITIATIVES THAT SUPPORT ACCESS TO AND AVAILABILITY OF HEALTHY LIFESTYLE CHOICES, INITIATING EARLY-STAGE INTERVENTIONS FOR INDIVIDUALS AT HIGH RISK FOR CHRONIC DISEASE, AND DEVELOPING INTEGRATIVE CARE MODELS TO IMPROVE OUTCOMES FOR PATIENTS WITH CHRONIC DISEASE.
HOLY SPIRIT HOSPITAL	PART V, SECTION B, LINE 16J: THE FAP, FAP APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FAP ARE WIDELY AVAILABLE AT HTTPS://WWW.GEISINGER.ORG/PATIENT-CARE/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/NEED-HELP.PART V, LINE 16JIN ADDITION, REGISTRATION PERSONNEL ALSO REFER UNINSURED AND/OR LOW-INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY.
PART V, LINE 11 (CONTINUED)	ACCESS TO CAREGEISINGER HOLY SPIRIT HAS TAKEN NUMEROUS STEPS TO PROVIDE PEOPLE IN OUR LOCAL COMMUNITY WITH MORE ACCESS TO CARE. WE'VE HIRED MORE PROVIDERS IN PEDIATRICS, INTERNAL MEDICINE AND FAMILY MEDICINE. IN FACT, OUR NUMBER OF PROVIDERS IN THOSE AREAS IS UP 37% OVER LAST YEAR. WE'RE INTEGRATING PEDIATRICIANS INTO PRIMARY CARE CLINICS TO CREATE TRUE OPTIONS FOR FAMILY MEDICINE AND WHEN WE LEARNED THAT BOYS AGING OUT OF PEDIATRICS OFTEN PREFERRED TO BE SEEN BY A MALE PROVIDER, WE MADE SURE TO BALANCE OUR RECRUITMENT EFFORTS TO MEET THOSE NEEDS. WE IMPROVED OFFICE EFFICIENCY BY ADDING A DESIGNATED CALL CENTER FOR PRIMARY CARE APPOINTMENT SCHEDULING. CALLERS NO LONGER DEAL WITH VOICE MAIL AND CAN BE SCHEDULED RIGHT AWAY WHILE REGULAR STAFF IS FREED UP TO DO OTHER THINGS. OUR APPOINTMENTS HAVE INCREASED 20% TO 23% SINCE THE CALL CENTER OPENED.GEISINGER HOLY SPIRIT HAS ALSO REDESIGNED TRANSITIONS OF CARE SO THAT PATIENTS DISCHARGED FROM THE HOSPITAL ARE SEEN BY THEIR PRIMARY CARE PROVIDERS WITHIN TWO TO FIVE DAYS. THIS APPROACH HAS CUT DOWN ON READMISSION RATES SIGNIFICANTLY BECAUSE PREVIOUSLY, PATIENTS WOULD WAIT TWO TO THREE WEEKS TO BE SEEN AND OFTEN NEEDED ATTENTION BEFORE THEN. WE ARE ALSO IMPROVING ACCESS TO CARE BY PARTNERING WITH COMMUNITY AGENCIES AND HEALTHCARE COALITIONS, ESPECIALLY IN PERRY COUNTY, WHICH IS IN THE BOTTOM 5% OF COUNTIES IN PENNSYLVANIA TO HAVE HEALTHCARE PROVIDERS. GEISINGER HOLY SPIRIT HAS A STRONG PRESENCE ON MANY BOARDS OF DIRECTORS. WE WORK WITH THE UNITED WAY AND HAMILTON HEALTHCARE TO ENSURE TWO COMMUNITY HEALTH WORKS ARE ON SITE AT THE HOSPITAL, ESPECIALLY IN THE EMERGENCY DEPARTMENT, LOOKING FOR PEOPLE WITHOUT PRIMARY CARE PROVIDERS OR INSURANCE TO HELP THEM FIND THE COVERAGE AND CARE THEY NEED. THIS COORDINATED EFFORT HAS SHOWN IMPRESSIVE RESULTS. GEISINGER HOLY SPIRIT IS EXTENDING SPECIALTY CARE OUTREACH BY SENDING CARDIOLOGISTS, ORTHOPEDISTS AND PHARMACISTS OUT TO CLINICS IN MORE RURAL LOCATIONS ON A WEEKLY BASIS. WE ARE CURRENTLY LOOKING FOR FUNDING TO OFFER MORE TELEMEDICINE OPTIONS. ONE PROGRAM WE DO HAVE IN PLACE IS A PARTNERSHIP WITH LEHIGH VALLEY MEDICAL CENTER, THROUGH WHICH CONSULTATIONS WITH REMOTE BURN SPECIALISTS ARE PROVIDED ALONG WITH TRANSFERS, WHEN NECESSARY. TO ENCOURAGE INTEREST IN MEDICAL CAREERS, OUR ADVANCED PRACTITIONERS REACH OUT TO COMMUNITY HIGH SCHOOLS AND COLLEGES AS WELL AS THE REGIONAL CAMPUS OF THE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE.
PART V, LINE 11 (CONTINUED)	BEHAVIORAL HEALTHGEISINGER HOLY SPIRIT TEENLINE HAS BEEN HELPING STUDENTS, FAMILIES, AND COMMUNITY MEMBERS IN THE CUMBERLAND-PERRY COUNTY AREA FOR 34 YEARS. TEENLINE OPERATES ON THE PENNSYLVANIA STATE STUDENT ASSISTANCE PROGRAM MODEL (SAP). TEENLINE COUNSELORS PROVIDE MENTAL HEALTH ASSESSMENTS AS AN OUTCOME OF THE SAP SCREENING AND RECOMMENDATION PROCESS. TEENLINE ASSISTS FAMILIES WITH CONNECTING WITH RECOMMENDED SERVICES ONCE THEY HAVE COMPLETED THE ASSESSMENT AND DISCUSSED RECOMMENDATIONS WITH THE FAMILY. IN THE SCHOOL YEAR 2017-18, TEENLINE CONDUCTED 611 MENTAL HEALTH ASSESSMENTS; IN THE SCHOOL YEAR 2018-19, 650 STUDENTS RECEIVED A MENTAL HEALTH ASSESSMENT.IN ADDITION, TEENLINE ATTENDS SCHOOL FUNCTIONS, SUCH AS PTO MEETINGS AND BACK TO SCHOOL NIGHTS, TO INCREASE MENTAL HEALTH AWARENESS, SHARE INFORMATION FOR STUDENT ASSISTANCE PROGRAMS AND ANSWER QUESTIONS. TEENLINE COUNSELORS CONDUCT IN-SERVICES ON REQUESTED MENTAL HEALTH TOPICS TO ASSIST SCHOOL PERSONNEL WITH MENTAL HEALTHRELATED INFORMATION. IN 2019, TEENLINE HAD 20 SCHOOL MENTAL HEALTH PRESENTATIONS. THEY WORK CLOSELY WITH SCHOOL ADMINISTRATION AND STAFF AND GIVE INPUT INTO PROCEDURES FOR SAP.TEENLINE COUNSELORS RESPOND TO REQUESTS FOR ASSISTANCE WHEN THERE IS A DEATH OF A STUDENT OR STAFF MEMBER. IN 2018, TEENLINE RESPONDED TO 8 POSTVENTIONS AND 10 POSTVENTIONS IN 2019.THE GEISINGER HOLY SPIRIT BEHAVIORAL HEALTH DEPARTMENT OFFERS A WEEKLY SUPPORT GROUP FOR EXPECTING AND NEW MOTHERS, PARTICULARLY WITH A FOCUS ON MOTHERS WHO HAVE A BEHAVIORAL HEALTH DIAGNOSIS AND ARE STRUGGLING OR SYMPTOMATIC. OVER THE PAST 2 YEARS, GROUP MEMBERS HAVE BEEN MORE BLENDED. WE FOUND THAT MEMBERS WERE USING MORE ONLINE TOOLS AND WERE ALSO ABLE TO FIND INFORMATION ABOUT THE GROUP. THUS, THIS HAS SHIFTED OUR THINKING AND DESIGN OF THE GROUP. IT IS INCLUSIVE OF ALL WOMEN WHO ARE PREGNANT OR POSTPARTUM, AND WE CAN IDENTIFY WOMEN WHO ARE EXPERIENCING CLINICAL PERI-PARTUM AND POSTPARTUM ISSUES EARLIER. WE SERVED 15 WOMEN IN 2019, WHO ATTENDED AT LEAST 2 TIMES A MONTH FOR 13 MONTHS.WE ALSO HAVE IDENTIFIED PROVIDERS WHO SPECIALIZE IN BEHAVIORAL HEALTH ISSUES DURING PERI-PARTUM AND POSTPARTUM PERIODS.GEISINGER HOLY SPIRIT MATERNAL ASSISTANCE PROGRAM OFFERS INTENSIVE CASE MANAGEMENT TO WOMEN IN THE PRENATAL THROUGH POSTPARTUM STAGE. THE PROGRAM OFFERS HOME VISITS, FOLLOW-UP, SUBSTANCE ABUSE TREATMENT REFERRAL, EDUCATION, AND SMOKING CESSATION INFORMATION. THE GOAL IS TO ASSIST WOMEN TO DELIVER A HEALTHY BABY AND OFFER SUPPORT TO LIVE A SUBSTANCE-FREE LIFESTYLE.IN AN EFFORT TO INTEGRATE BEHAVIORAL HEALTH SERVICES WITH PRIMARY CARE, GEISINGER HOLY SPIRIT IDENTIFIED TWO PSYCHIATRISTS FOR INTEGRATION. HOWEVER, BOTH PROVIDERS HAVE EITHER LEFT THE EMPLOYMENT OF GHS OR ARE NOW FLEX PROVIDERS. OUR GOAL IS TO RE-EVALUATE OUR POOL OF PROVIDERS IN ADDITION TO HIRING, AND EARMARK BEHAVIORAL HEALTH INTEGRATION INTO PRIMARY CARE AS A PRIORITY.
PART V, LINE 11 (CONTINUED)	CHRONIC DISEASE MANAGEMENT AND PREVENTIONGEISINGER HOLY SPIRIT ENCOURAGES COMMUNITY INITIATIVES THAT SUPPORT ACCESS TO AND AVAILABILITY OF HEALTHY LIFESTYLE CHOICES. WE OFFER FREE PROGRAMS TO LOCAL RESIDENTS, INCLUDING THE MYCODE INNOVATIONS IN HEALTHCARE SERIES AS WELL AS LECTURES ON DIABETES AND HEART DISEASE, UNDERSTANDING HEART MEDICATIONS AND PARTIAL KNEE REPLACEMENTS.WE PROVIDE SUBSIDIZED EXERCISE CLASSES FOR SILVER CIRCLE MEMBERS AGE 55 OR OLDER AND SUPPORT COMMUNITY RACES, FUN RUNS, WALKS AND OTHER EVENTS THAT PROMOTE PHYSICAL ACTIVITY, INCLUDING FURRY FRIENDS, RACE FOR THEIR LIVES, ZERO PROSTATE CANCER WALK/RUN, TUSCARORA WILDLAND FIRE CREW, 5K BRUSH RUSH, SHAULL ELEMENTARY SCHOOL, FUN RUN, ROTARY CLUB OF MECHANICSBURG, 5K RUN TO END POLIO, ST. JOSEPH'S SCHOOL, RACE FOR EDUCATION AND THE KIWANIS CLUB OF DILLSBURG, 5K PICKLE CHASE.WE PARTICIPATE IN OR HOST FREE COMMUNITY HEALTH FAIRS TARGETING DIVERSE POPULATIONS, INCLUDING A MEN'S HEALTH EVENT IN PARTNERSHIP WITH UCPA (OFFERING PSA BLOOD TEST, BLOOD PRESSURE SCREENINGS, BMI, BONE DENSITY, SLEEP ASSESSMENT), 11/3 SCREENING EVENT (BLOOD PRESSURE, CHOLESTEROL/GLUCOSE, BONE DENSITY, BMI, MYCODE, CARDIAC RISK ASSESSMENT), A DAY OF PAMPERING AT FIRST UNITED METHODIST CHURCH, MECHANICSBURG (BONE DENSITY, BLOOD PRESSURE SCREENINGS AND SLEEP ASSESSMENTS FOR CAREGIVERS), PAXTONIA ELEMENTARY SCHOOL SCIENCE NIGHT (HAND HYGIENE), NATIONWIDE EMPLOYEE HEALTH FAIR (BONE DENSITY) AND 5/22 SKIN CANCER SCREENING EVENT.WE OFFER FREE OR REDUCED-COST CLASSES AND SUPPORT GROUPS FOR EXPECTANT MOTHERS AND THEIR FAMILIES, INCLUDING CHILDBIRTH PREP, BEAR ESSENTIALS, MOM'S PLACE SUPPORT GROUP AND BREASTFEEDING/PUMPING.WE PROVIDE DIABETES PREVENTION AND MANAGEMENT EDUCATION AND SCREENINGS AND FEATURE HOSPITAL MEDICAL PROVIDERS AT COMMUNITY HEATH EVENTS AND DOCTALK SEGMENTS ON THE LOCAL TELEVISION STATION.

Schedule H (Form 990) 2019

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

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Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
PART I, LINE 3C:	SUPPORTING DOCUMENTATION FOR ELIGIBILITY MAY CONSIST OF INCOME AND ASSET INFORMATION, INCLUSIVE BUT NOT LIMITED TO: FEDERAL INCOME TAX FORM 1040 FROM THE PRIOR YEAR, PAY STUB COPIES, WRITTEN VERIFICATION OF ANY OTHER INCOME RECEIVED (I.E. SOCIAL SECURITY, ADC, CHILD SUPPORT, ALIMONY, ETC.), CURRENT CREDIT REPORTS AND ASSET VERIFICATION. THE HOSPITAL MAY ALSO UTILIZE INDUSTRY TESTED EXTERNAL ANALYTICAL TOOLS TO QUALIFY PATIENTS FOR UNCOMPENSATED CARE (AKA PRESUMPTIVE CHARITY).GEISINGER PROVIDERS, WITHOUT DISCRIMINATION, CARE FOR ALL EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR FINANCIAL ASSISTANCE ELIGIBILITY OR ABILITY TO PAY. IT IS THE POLICY OF GEISINGER HOSPITAL FACILITIES TO COMPLY WITH THE STANDARDS OF THE FEDERAL EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR TRANSPORT ACT OF 1986 ("EMTLA") AND REGULATIONS IN PROVIDING MEDICAL SCREENING EXAMINATION AND SUCH FURTHER TREATMENT AS MAY BE NECESSARY TO STABILIZE AN EMERGENCY MEDICAL CONDITION FOR ANY INDIVIDUAL PRESENTING TO THE EMERGENCY DEPARTMENT SEEKING TREATMENT.
PART I, LINE 6A:	A SUMMARY OF THE COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL AND ITS RELATED CHARITABLE ORGANIZATIONS IS INCLUDED IN GEISINGER'S ANNUAL REPORT AND IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
PART I, LINE 7:	A COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COSTS REPORTED ON LINE 7 AND ADDRESSED PATIENT SEGMENTS BY PAYOR (E.G. MEDICARE, MEDICAID, COMMERCIAL PAYERS, SELF-PAY, ETC.). A COST TO CHARGE RATIO, CALCULATED PURSUANT TO WORKSHEET 2 OF THE FORM 990 INSTRUCTIONS, WAS USED TO CALCULATE THE COST OF CHARITY CARE.
PART I, LINE 7G:	THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED IN SUBSIDIZED HEALTH SERVICES.
PART III, LINE 2:	REFER TO THE RESPONSE FOR PART III, LINE 4.
PART III, LINE 3:	PATIENTS' ACCOUNTS ARE MONITORED THROUGHOUT THE BILLING PROCESS AND ARE RECLASSIFIED TO CHARITY CARE (100% DISCOUNTED CARE) WHENEVER A PATIENT BECOMES ELIGIBLE UNDER THE HOSPITAL'S UNCOMPENSATED OR CHARITY CARE POLICIES.THE HOSPITAL ESTIMATES THAT APPROXIMATELY 14% OF THE BAD DEBT ACCOUNTS ARE SUBSEQUENTLY RECLASSIFIED TO UNCOMPENSATED OR CHARITY CARE.
PART III, LINE 4:	GEISINGER HEALTH AND ITS AFFILIATES ("GEISINGER"), THAT INCLUDES THE HOSPITAL, PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS, ANNUALLY. FOOTNOTE 3, SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES BEGINNING AT PAGE 8 WITHIN THESE FINANCIAL STATEMENTS INCLUDES A DESCRIPTION OF THE ACCOUNTING FOR NET PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE. THIS DISCLOSURE ALSO DESCRIBES THE RELATED EXPLICIT AND IMPLICIT PRICE CONCESSIONS AND BAD DEBTS EXPENSE. CHARITY CARE IS ALSO DESCRIBED IN THE SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES. GEISINGER'S PRICE CONCESSIONS, BAD DEBTS AND CHARITY CARE METHODOLOGIES ARE CONSISTENTLY APPLIED ACROSS ALL CHARITABLE AFFILIATES.
PART III, LINE 8:	MEDICARE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM.THE ORGANIZATION BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND THE COST OF BAD DEBT ARE COMMUNITY BENEFIT AND SHOULD BE INCLUDED ON FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW, THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND IS CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER THE INTERNAL REVENUE CODE ("IRC") 501(C)(3).SATISFYING THE "COMMUNITY BENEFIT STANDARD," AS ARTICULATED BY THE INTERNAL REVENUE SERVICE (IRS) IN REVENUE RULING 69-545, IS CURRENTLY REQUIRED FOR A HOSPITAL TO BE RECOGNIZED AS A CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE (IRC) 501(C)(3). THIS RULING REMOVED THE PREVIOUS REQUIREMENT OF REVENUE RULING 56-185, KNOWN AS THE "CHARITY CARE STANDARD," THAT IN ORDER TO BE A CHARITABLE ORGANIZATION, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR THEIR CARE. THIS EARLIER RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT MEAN THAT A HOSPITAL WAS CHARITABLE SINCE THAT LEVEL COULD REFLECT THE HOSPITAL'S FINANCIAL ABILITY TO PROVIDE SUCH CARE. REVENUE RULING 56-185 ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT IMPACT A HOSPITAL'S CHARITABLE STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS.AS DEVELOPED IN REVENUE RULING 69-545, UNDER THE COMMUNITY BENEFIT STANDARD, HOSPITALS WERE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THIS RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED THOSE WHO COULD PAY FOR THE SERVICES EITHER BY THEMSELVES, THROUGH PRIVATE INSURANCE OR PUBLIC PROGRAMS SUCH AS MEDICARE. IN ADDITION, THE HOSPITAL OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL WAS CHARITABLE BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM CHARITABLE, AS REQUIRED BY TREASURY REGULATION SECTION 1.501 (C)(3)-1(D)(2). THE IRS RULED THAT THE PROMOTION OF HEALTH, LIKE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES OF THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY.THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO THOSE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER FACTORS THAT DEMONSTRATED COMMUNITY BENEFIT INCLUDED: SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND FACILITIES AND ADVANCE MEDICAL TRAINING, EDUCATION AND RESEARCH; AND IT WAS CONTROLLED BY A BOARD OF DIRECTORS THAT CONSISTED OF INDEPENDENT CIVIC LEADERS.THE AMERICAN HOSPITAL ASSOCIATION ("AHA") BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALLS) AND BAD DEBT SHOULD BE REPORTED AS COMMUNITY BENEFIT ON FORM 990, SCHEDULE H, PART I, LINE 7. THIS ORGANIZATION AGREES WITH THE AHA'S LETTER TO THE IRS DATED AUGUST 21, 2007 RESPONDING TO A DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA ARGUED THAT MEDICARE UNDERPAYMENTS (SHORTFALLS) IS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: -PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS REMAINS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD.-MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES ONLY 92 CENTS FOR EVERY DOLLAR HOSPITALS SPEND TO CARE FOR MEDICARE PATIENTS.-MANY MEDICARE PATIENTS, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46% OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200% OF THE FEDERAL POVERTY LEVEL. MANY ARE ALSO ELIGIBLE FOR MEDICAID, SO CALLED DUAL ELIGIBLES".PENNSYLVANIA REQUIRES NON-PROFIT HOSPITALS TO PROVIDE A MINIMUM LEVEL OF COMMUNITY BENEFIT TO RETAIN EXEMPTION FROM STATE AND LOCAL TAXES. ACCORDING TO STATE GUIDANCE AND CASE LAW, THE UNREIMBURSED COST OF MEDICARE AND BAD DEBT IS CONSIDERED TO BE COMMUNITY BENEFIT FOR STATE TAX EXEMPTION PURPOSES.PART III, LINE 6 ONLY INCLUDES THOSE COSTS THAT ARE PERMITTED TO BE REPORTED IN THE HOSPITAL'S MEDICARE COST REPORT THAT IS REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT. THE HOSPITAL CONSIDERS THE TOTAL MEDICARE UNDERPAYMENTS (SHORTFALL) OF $23,650,410 SHOULD BE REPORTED AS COMMUNITY BENEFIT ON THE FORM 990, SCHEDULE H, PART I, LINE 7. ALONG WITH PROVIDING CARE TO MEDICAID PATIENTS AND PROVIDING FREE OR DISCOUNTED CARE TO OTHER LOW-INCOME PATIENTS, THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. LIKE MEDICAID, MEDICARE DOES NOT PAY THE FULL COST OF PROVIDING CARE TO THESE PATIENTS, FORCING THE HOSPITAL TO USE OTHER FUNDS TO COVER THE SHORTFALL. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THE MEDICARE SHORTFALL AND IS THEREBY PROVIDING ACCESS TO MEDICAL SERVICES FOR THE ELDERLY AND RELIEVING THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR PROVIDING CARE TO MEDICARE PATIENTS. ABSENT THE MEDICARE PROGRAM, IT IS LIKELY THAT MANY MEDICARE PATIENTS WOULD BE ELIGIBLE FOR CHARITY CARE OR OTHER NEED-BASED GOVERNMENT PROGRAMS. THE AMOUNT EXPENDED TO COVER THE SHORTFALL IS MONEY NOT AVAILABLE FOR FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS.BOTH THE HOSPITAL AND THE AHA BELIEVE THAT PATIENT BAD DEBT BE REPORTED AS A COMMUNITY BENEFIT ON FORM 990, SCHEDULE H, PART I, LINE 7. LIKE MEDICARE UNDERPAYMENTS (SHORTFALLS), BAD DEBT SHOULD BE REPORTED AS COMMUNITY BENEFIT BECAUSE:-A SIGNIFICANT PORTION OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO FOR MANY REASONS DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY UNDER THE HOSPITAL'S CHARITY CARE OR FINANCIAL ASSISTANCE POLICY (FAP). A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO"), "NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFIT", CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." -THE CBO REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF THE BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR CHARITABLE MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THE EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ACCORDING TO THE CBO REPORT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. (IN FY 2020, APPROXIMATELY 14% OF THE HOSPITAL'S BAD DEBT WAS SUBSEQUENTLY RECLASSIFIED TO CHARITY CARE.) THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE (BAD DEBT AND CHARITY CARE) AS A MEASURE OF COMMUNITY BENEFITS" ASSUMING THE FINDINGS ARE GENERALIZED NATIONALLY. THE EXPERIENCE OF HOSPITALS NATIONWIDE REINFORCE THAT THEY ARE GENERALIZABLE.AS OUTLINED BY THE AHA, DESPITE THE HOSPITAL'S BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE CHARITABLE MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS' BEAR IN SERVING ALL PATIENTS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. IN ADDITION, THE HOSPITAL INVESTS SIGNIFICANT RESOURCES IN SYSTEMS AND STAFF TRAINING TO ASSIST PATIENTS THAT ARE IN NEED OF FINANCIAL ASSISTANCE. FOR FISCAL YEAR ENDED 6/30/2020, THE HOSPITAL'S COST OF PROVIDING PATIENT CARE FOR SERVICES ACCOUNTED FOR AS BAD DEBT WAS $1,261,870
PART III, LINE 9B:	THE HOSPITAL IS COMMITTED TO PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND THE HOSPITAL'S COLLECTION ACTIONS ARE CONSISTENTLY APPLIED TO ALL PATIENTS. IT IS THE HOSPITAL'S POLICY TO PROVIDE FINANCIAL ASSISTANCE AND COUNSELING TO PATIENTS WITH LIMITED FINANCIAL MEANS. A PATIENT MAY BECOME ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIAL/BILLING AND COLLECTION PROCESS. IN ANY STAGE OF THE BILLING PROCESS, COLLECTION ACTIONS ARE NOT PURSUED WHENEVER A PATIENT APPLIES AND IS BEING EVALUATED FOR FINANCIAL ASSISTANCE.UNDER NO CIRCUMSTANCES WILL THE HOSPITAL FREEZE OR ATTACH BANK ACCOUNTS OF A PATIENT, ENFORCE LIENS, ACTIVELY PURSUE ASSETS FROM A PRIOR JUDGMENT OR GARNISH THE WAGES OF A PATIENT AND/OR FAMILY MEMBER BEFORE DETERMINING IF THE PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM.GEISINGER MANAGEMENT HAS DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR GOVERNMENTAL PROGRAMS OR FINANCIAL ASSISTANCE FROM GEISINGER AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY HIS OR HER PAYMENT AGREEMENTS.BILLING AND COLLECTION POLICY: THE BILLING AND COLLECTION POLICY IS ADMINISTERED IN ACCORDANCE WITH THE MISSION AND VALUES OF THE HOSPITAL AS WELL AS FEDERAL AND STATE LAW. THE POLICY IS DESIGNED TO PROMOTE APPROPRIATE ACCESS TO MEDICAL CARE FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY WHILE MAINTAINING GEISINGER'S FISCAL RESPONSIBILITY TO MAXIMIZE REIMBURSEMENT AND MINIMIZE BAD DEBT.THE ORGANIZATION'S BILLING AND COLLECTION POLICY IS INTENDED TO TAKE INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. THE ORGANIZATION MAKES SURE THAT PATIENTS ARE ASSISTED IN OBTAINING HEALTH INSURANCE COVERAGE FROM PRIVATELY AND PUBLICLY FUNDED SOURCES, WHENEVER POSSIBLE.ALL BUSINESS OFFICE CUSTOMER SERVICE DEPARTMENT REPRESENTATIVES ARE EDUCATED ON ALL ASPECTS OF THE BILLING AND COLLECTION POLICY AND ARE EXPECTED TO ADMINISTER THE POLICY ON A REGULAR AND CONSISTENT BASIS. BUSINESS OFFICE CUSTOMER SERVICE REPRESENTATIVES ARE HELD ACCOUNTABLE TO TREAT ALL PATIENTS WITH COURTESY, RESPECT, CONFIDENTIALITY AND CULTURAL SENSITIVITY.THE BILLING AND COLLECTION POLICY IS ADMINISTERED IN CONJUNCTION WITH THE PROCEDURES OUTLINED IN INTERNAL ADMINISTRATIVE POLICIES. THE GEISINGER EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND VICE PRESIDENT, CHIEF REVENUE OFFICER HAVE OVERALL RESPONSIBILITY FOR THE BILLING AND COLLECTION ACTIVITIES OF THE HOSPITAL. THE BUSINESS OFFICE CUSTOMER SERVICE DEPARTMENT STAFF IS RESPONSIBLE FOR THE DAY-TO-DAY ENFORCEMENT OF APPROVED POLICIES AND PROCEDURES. GEISINGER MAY OFFER EXTENDED PAYMENT PLANS TO PATIENTS WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS.EMERGENCY & MEDICALLY NECESSARY SERVICES: GEISINGER DOES NOT ENGAGE IN ANY ACTIONS THAT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE. THE ORGANIZATION WILL NEVER DEMAND THAT AN EMERGENCY DEPARTMENT PATIENT PAY BEFORE RECEIVING TREATMENT FOR EMERGENCY MEDICAL CONDITIONS. ADDITIONALLY, GEISINGER DOES NOT PERMIT DEBT COLLECTION ACTIVITIES IN THE EMERGENCY DEPARTMENT OR OTHER AREAS WHERE SUCH ACTIVITIES COULD INTERFERE WITH THE PROVISION OF EMERGENCY CARE ON A NONDISCRIMINATORY BASIS. ALL MEDICALLY NECESSARY HOSPITAL SERVICES ARE PROVIDED WITHOUT CONSIDERATION OF ABILITY TO PAY AND ARE NOT DELAYED PENDING APPLICATION OR APPROVAL OF MEDICAL ASSISTANCE OR THE GEISINGER FINANCIAL ASSISTANCE PROGRAM. ADVANCE PAYMENT IS NOT REQUIRED FOR ANY MEDICALLY NECESSARY SERVICES.COMPLIANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(6): GEISINGER DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS ("ECAS") AS DEFINED BY INTERNAL REVENUE CODE SECTION 501(R)(6) PRIOR TO THE EXPIRATION OF THE NOTIFICATION PERIOD. THE NOTIFICATION PERIOD IS DEFINED AS A 120-DAY PERIOD OR GREATER, WHICH BEGINS ON THE DATE OF THE 1ST POST-DISCHARGE BILLING STATEMENT, IN WHICH NO ECAS ARE INITIATED AGAINST THE PATIENT.SUBSEQUENT TO THE NOTIFICATION PERIOD GEISINGER, OR ANY THIRD PARTIES ACTING ON ITS BEHALF, MAY INITIATE THE FOLLOWING ECAS AGAINST A PATIENT FOR AN UNPAID BALANCE IF THE FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION HAS NOT BEEN MADE OR IF AN INDIVIDUAL IS INELIGIBLE FOR FINANCIAL ASSISTANCE. GEISINGER MAY AUTHORIZE THIRD PARTIES TO REPORT ADVERSE INFORMATION ABOUT THE INDIVIDUAL TO CONSUMER CREDIT REPORTING AGENCIES OR CREDIT BUREAUS ON DELINQUENT PATIENT ACCOUNTS AFTER THE NOTIFICATION PERIOD.THE ORGANIZATION ENSURES REASONABLE EFFORTS HAVE BEEN TAKEN TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY AND ENSURES THE FOLLOWING ACTIONS ARE TAKEN AT LEAST 30 DAYS PRIOR TO INITIATING ANY ECA: 1) THE PATIENT IS PROVIDED WITH WRITTEN NOTICE WHICH: INDICATES THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE PATIENTS; IDENTIFIES THE ECA(S) THAT GEISINGER INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE; AND STATES A DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. 2) THE PATIENT IS PROVIDED WITH A COPY OF THE PLAIN LANGUAGE SUMMARY; AND 3) REASONABLE EFFORTS ARE MADE TO ORALLY NOTIFY THE PATIENT ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS.GEISINGER PROCESSES ALL APPLICATIONS FOR FINANCIAL ASSISTANCE SUBMITTED DURING THE APPLICATION PERIOD. THE APPLICATION PERIOD BEGINS ON THE DATE THE CARE IS PROVIDED AND ENDS ON THE 240TH DAY AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT.
PART VI, LINE 2:	A COLLABORATIVE APPROACH TO COMMUNITY HEALTH IMPROVEMENTTHE FY19 GEISINGER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL. THE STUDY AREA INCLUDED 19 COUNTIES ACROSS CENTRAL, NORTHEASTERN, AND SOUTH CENTRAL PENNSYLVANIA WHICH REPRESENT THE COLLECTIVE SERVICE AREAS OF THE COLLABORATING HOSPITALS. TO DISTINGUISH UNIQUE SERVICE AREAS AMONG HOSPITALS AND FOSTER COOPERATION WITH LOCAL COMMUNITY PARTNERS TO IMPACT HEALTH NEEDS, REGIONAL RESEARCH AND LOCAL REPORTING WAS DEVELOPED. THE COLLABORATING HEALTH SYSTEMS AGREED THAT BY COORDINATING EFFORTS TO IDENTIFY COMMUNITY HEALTH NEEDS ACROSS THE REGION, THE HEALTH SYSTEMS WOULD CONSERVE COMMUNITY RESOURCES WHILE DEMONSTRATING LEADERSHIP IN CONVENING LOCAL COMMUNITY PARTNERS TO ADDRESS COMMON PRIORITY NEEDS. BEST PRACTICES IN COMMUNITY HEALTH IMPROVEMENT DEMONSTRATE THAT FOSTERING "COLLECTIVE IMPACT" IS AMONG THE MOST SUCCESSFUL WAYS TO AFFECT THE HEALTH OF A COMMUNITY. COLLECTIVE IMPACT IS ACHIEVED BY COMMITTING A DIVERSE GROUP OF STAKEHOLDERS TOWARD A COMMON GOAL OR ACTION, PARTICULARLY TO IMPACT DEEP ROOTED SOCIAL OR HEALTH NEEDS. BY TAKING A COLLABORATIVE APPROACH TO THE CHNA, GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL ARE LEADING THE WAY TO IMPROVE THE HEALTH OF COMMUNITIES IN CENTRAL, NORTHEASTERN, AND SOUTH CENTRAL PENNSYLVANIA. THE FOLLOWING PAGES DESCRIBE THE PROCESS AND RESEARCH METHODS USED IN THE FY2019 CHNA AND THE FINDINGS THAT PORTRAY THE HEALTH STATUS OF THE COMMUNITIES WE SERVE AND OUTLINE OPPORTUNITIES TO WORK WITH OUR COMMUNITY PARTNERS TO ADVANCE HEALTH AMONG ALL RESIDENTS ACROSS OUR SERVICE AREAS.SEE ALSO THE DISCUSSION RELATED TO THE RESPONSE TO PART V, LINE 5.
PART VI, LINE 3:	FOR URGENT AND EMERGENT SERVICES, PATIENTS ARE PROVIDED CARE REGARDLESS OF THEIR ABILITY TO PAY. IN THE EVENT A PATIENT HAS AN EMERGENCY MEDICAL CONDITION; TREATMENT IS NOT DELAYED TO PERMIT AN INQUIRY REGARDING A PATIENT'S METHOD OF PAYMENT OR INSURANCE STATUS. FOR OTHER THAN URGENT AND EMERGENT SERVICES, THE HOSPITAL PROVIDES UNCOMPENSATED CARE, FREE OF CHARGE, OR ON A 100% DISCOUNTED BASIS, TO THOSE PATIENTS WHO DEMONSTRATE AN INABILITY TO PAY. DEPENDING UPON FAMILY SIZE AND INCOME, FREE OR 100% DISCOUNTED SERVICES ARE AVAILABLE TO A PATIENT WITH FAMILY INCOME OF 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. IT IS THE HOSPITAL'S POLICY TO PROVIDE FINANCIAL ASSISTANCE AND FINANCIAL COUNSELING TO PATIENTS OF LIMITED MEANS.A PATIENT MAY BECOME ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIAL/BILLING PROCESS. INFORMATION (SIGNS, BROCHURES, ETC.) REGARDING THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES ARE PROVIDED AT THE EMERGENCY ROOM, REGISTRATION AND VARIOUS ACCESS POINTS THROUGHOUT THE HOSPITAL.REGISTRATION PERSONNEL ALSO REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. NOTICE OF THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES CAN ALSO BE FOUND ON THE GEISINGER WEB SITE AT WWW.GEISINGER.ORG. PATIENTS ARE ALSO PROVIDED INFORMATION ON THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES WITH EACH PATIENT BILL.THE FINANCIAL ASSISTANCE POLICY ("FAP"), THE FAP APPLICATION AND PLAIN LANGUAGE SUMMARY ("PLS") ARE AVAILABLE ON-LINE. PAPER COPIES ARE AVAILABLE UPON REQUEST WITHOUT CHARGE BY MAIL OR ARE AVAILABLE AT REGISTRATION AREAS WHICH INCLUDES EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL-BASED CLINICS AND PATIENT FINANCIAL SERVICES DEPARTMENTS. ALL FAP DOCUMENTS ARE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGE OF POPULATIONS WITH LIMITED ENGLISH PROFICIENCY ("LEP") THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE HOSPITAL'S SERVICE AREA. SIGNS OR DISPLAYS ARE CONSPICUOUSLY POSTED IN PUBLIC HOSPITAL LOCATIONS INCLUDING THE EMERGENCY DEPARTMENT, ADMISSIONS DEPARTMENT AND REGISTRATION DEPARTMENT THAT INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. ALL PATIENTS ARE OFFERED A COPY OF THE PLS AS PART OF THE INTAKE AND DISCHARGE PROCESSES. ADDITIONALLY, FINANCIAL COUNSELORS AND CUSTOMER SERVICE REPRESENTATIVES ARE AVAILABLE TO ASSIST PATIENTS WITH CONCERNS.
PART VI, LINE 4:	GEISINGER HOLY SPIRIT PRIMARILY SERVES RESIDENTS IN 25 ZIP CODES SPANNING CUMBERLAND, DAUPHIN, PERRY, AND YORK COUNTIES IN PENNSYLVANIA. THE 2017 POPULATION OF THE SERVICE AREA IS 454,584 AND IS PROJECTED TO INCREASE 3.7% BY 2022.ZIP CODE OF RESIDENCE IS ONE OF THE MOST IMPORTANT PREDICTORS OF HEALTH DISPARITY; WHERE RESIDENTS LIVE MATTERS IN DETERMINING THEIR HEALTH. THE COMMUNITY NEED INDEX (CNI) WAS DEVELOPED BY DIGNITY HEALTH AND TRUVEN HEALTH ANALYTICS TO ILLUSTRATE THE POTENTIAL FOR HEALTH DISPARITY AT THE ZIP CODE LEVEL. THE CNI SCORES ZIP CODES ON A SCALE OF 1.0 (LOW NEED) TO 5.0 (HIGH NEED) BASED ON 2015 DATA INDICATORS FOR FIVE SOCIO-ECONOMIC BARRIERS:- INCOME: POVERTY AMONG ELDERLY HOUSEHOLDS, FAMILIES WITH CHILDREN, AND SINGLE FEMALE-HEADED FAMILIES WITH CHILDREN - CULTURE/LANGUAGE: MINORITY POPULATIONS AND ENGLISH LANGUAGE BARRIERS- EDUCATION: POPULATION OVER 25 YEARS WITHOUT A HIGH SCHOOL DIPLOMA- INSURANCE COVERAGE: UNEMPLOYMENT RATE AMONG POPULATION 16 YEARS OR OVER AND POPULATION WITHOUT HEALTH INSURANCE- HOUSING STATUS: HOUSEHOLDERS RENTING THEIR HOMETHE WEIGHTED AVERAGE CNI SCORE FOR GEISINGER HOLY SPIRIT'S 25 ZIP CODE SERVICE AREA IS 2.5, INDICATING LOWER OVERALL COMMUNITY NEED. SEVERAL ZIP CODES WITHIN HARRISBURG HAVE HIGHER CNI SCORES, INCLUDING 17102, 17104, 17110, AND 17113. ZIP CODE 17104 HAS THE HIGHEST SCORE (4.8). A SIGNIFICANT PORTION OF HARRISBURG CITY IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA. POPULATIONS IN HARRISBURG ZIP CODES 17104 AND 17102 HAVE THE HIGHEST POVERTY, UNEMPLOYMENT, AND/OR UNINSURED RATES; ZIP CODE 17104 ALSO HAS THE LOWEST EDUCATIONAL ATTAINMENT AMONG RESIDENTS. POPULATIONS IN THE ZIP CODES ARE DIVERSE; APPROXIMATELY 38% TO 47% OF RESIDENTS IDENTIFY AS BLACK/AFRICAN AMERICAN AND 12% TO 31% OF RESIDENTS IDENTIFY AS HISPANIC/LATINO. RESIDENTS IN ZIP CODE 17043, LEMOYNE, ALSO EXPERIENCE POORER SOCIAL DETERMINANTS OF HEALTH. THE ZIP CODE HAS THE HIGHEST POVERTY AND UNINSURED RATES IN THE CUMBERLAND COUNTY SERVICE AREA. RESIDENTS ARE MORE LIKELY TO BE HISPANIC/LATINO AND SPEAK A LANGUAGE OTHER THAN ENGLISH. THE SOUTH CENTRAL REGION IS COMPRISED OF FOUR COUNTIES AND IS SERVED BY GEISINGER HOLY SPIRIT. THE SOUTH CENTRAL REGION POPULATION IS PRIMARILY WHITE, BUT DIVERSITY IS INCREASING. THE WHITE POPULATION AS A PERCENTAGE OF THE TOTAL POPULATION IS DECLINING IN ALL COUNTIES, WHILE BLACK/AFRICAN AMERICAN AND HISPANIC/LATINO POPULATIONS ARE GROWING. THE DEMOGRAPHIC SHIFT IS A STATEWIDE TREND; MINORITY POPULATIONS ARE THE ONLY GROWING DEMOGRAPHIC IN PENNSYLVANIA. THE HISPANIC/LATINO POPULATION IS ONE OF THE FASTEST GROWING DEMOGRAPHIC GROUPS; DAUPHIN AND YORK COUNTIES ARE PROJECTED TO EXPERIENCE THE GREATEST INCREASE IN THE POPULATION. PENNSYLVANIA FARES BETTER THAN THE NATION ON MOST ECONOMIC INDICATORS. PENNSYLVANIA RESIDENTS ARE LESS LIKELY TO LIVE IN POVERTY, HAVE A SIMILAR UNEMPLOYMENT RATE AS THE NATION'S AVERAGE, AND ARE MORE LIKELY TO HAVE ATTAINED AT LEAST A HIGH SCHOOL DIPLOMA. WITHIN THE SOUTH CENTRAL REGION, RESIDENTS HAVE A HIGHER MEDIAN HOUSEHOLD INCOME THAN THE STATE AND THE NATION, AND RESIDENTS IN ALL COUNTIES EXCEPT DAUPHIN HAVE LOWER POVERTY RATES. DAUPHIN COUNTY POVERTY RATES ARE SIMILAR TO STATE RATES. ALL COUNTIES ALSO HAVE A LOWER PERCENTAGE OF RESIDENTS WITH LESS THAN A HIGH SCHOOL EDUCATION WHEN COMPARED TO THE NATION. RACIAL AND ETHNIC MINORITY GROUPS LIKE BLACK/AFRICAN AMERICAN OR HISPANIC/LATINO RESIDENTS ARE MORE LIKELY TO BE IMPACTED BY ADVERSE SOCIOECONOMIC FACTORS, INCLUDING POVERTY, UNEMPLOYMENT, OR EDUCATION ATTAINMENT. POVERTY IS ONE OF THE BIGGEST DRIVERS OF DISPARITY IN THE SOUTH CENTRAL REGION. POVERTY RATES AMONG MINORITY POPULATIONS ARE DOUBLE THE RATES AMONG WHITES. SOCIOECONOMIC DISPARITY CONTRIBUTES TO WORSE HEALTH OUTCOMES. BECAUSE POPULATION COUNTS FOR MINORITY RESIDENTS ACROSS THE REGION ARE LOW, HEALTH DISPARITIES ARE PRIMARILY EVIDENCED BY STATE AND NATIONAL TRENDS. THE 2017 POPULATION OF THE SOUTH CENTRAL REGION IS 1,026,593. YORK COUNTY COMPRISES THE LARGEST PORTION OF THE POPULATION (44%), FOLLOWED BY DAUPHIN COUNTY (27%). COUNTY POPULATIONS ARE EXPECTED TO GROW WITH INCREASES OF 1% (PERRY) TO 6% (CUMBERLAND) BY 2022. THE SOUTH CENTRAL REGION POPULATION IS PRIMARILY WHITE, BUT INCREASINGLY DIVERSE. THE PERCENTAGE OF WHITE RESIDENTS DECREASED FROM 2010 TO 2017 AND IS PROJECTED TO DECREASE THROUGH 2022. THE PERCENTAGE OF RESIDENTS IDENTIFYING AS BLACK/AFRICAN AMERICAN AND/OR HISPANIC/LATINO IS INCREASING. DAUPHIN COUNTY HAS THE MOST DIVERSE POPULATION; RESIDENTS ARE LESS LIKELY TO SPEAK ENGLISH AS THEIR PRIMARY LANGUAGE WHEN COMPARED TO THE STATE. RESIDENTS IN ALL COUNTIES ARE MORE LIKELY TO SPEAK PRIMARILY ENGLISH WHEN COMPARED TO THE NATION. PENNSYLVANIA HAS A HIGHER MEDIAN AGE THAN THE NATION. THE MEDIAN AGE OF THE SOUTH CENTRAL REGION COUNTIES IS CONSISTENT WITH THE STATE. PERRY COUNTY HAS THE HIGHEST MEDIAN AGE, EXCEEDING THE NATION BY 5 POINTS. ALL SOUTH CENTRAL REGION COUNTIES HAVE A HIGHER MEDIAN HOUSEHOLD INCOME THAN THE STATE AND THE NATION. ALL COUNTIES EXCEPT DAUPHIN ALSO HAVE LOWER POVERTY RATES. DAUPHIN COUNTY POVERTY RATES ARE SIMILAR TO THE STATE. APPROXIMATELY 20% OF CHILDREN IN THE COUNTY LIVE IN POVERTY. CUMBERLAND AND DAUPHIN COUNTIES HAVE A MORE PROMINENT WHITE-COLLAR WORKFORCE COMPARED TO OTHER COUNTIES IN THE REGION AND THE STATE AND THE NATION. PERRY AND YORK COUNTIES HAVE A LARGER BLUE-COLLAR WORKFORCE. ALL COUNTIES EXCEPT YORK HAVE A LOWER UNEMPLOYMENT RATE THAN THE STATE AND THE NATION. THE YORK COUNTY UNEMPLOYMENT RATE IS SIMILAR TO THE NATION. HOMEOWNERSHIP IS A MEASURE OF HOUSING AFFORDABILITY AND ECONOMIC STABILITY. HOUSEHOLDERS IN ALL SERVICE COUNTIES EXCEPT DAUPHIN ARE MORE LIKELY TO OWN THEIR HOME WHEN COMPARED TO THE STATE AND THE NATION; DAUPHIN COUNTY MIRRORS THE NATION FOR HOME OWNERSHIP. DAUPHIN COUNTY HAS A SIMILAR MEDIAN HOUSEHOLD INCOME AND MEDIAN HOME VALUE TO PERRY COUNTY, BUT THE PERCENTAGE OF HOMEOWNERS IN PERRY COUNTY IS 10 POINTS HIGHER THAN IN DAUPHIN COUNTY. EDUCATION IS THE LARGEST PREDICTOR OF POVERTY AND ONE OF THE MOST EFFECTIVE MEANS OF REDUCING INEQUALITIES. RESIDENTS IN ALL SERVICE COUNTIES ARE MORE LIKELY TO HAVE GRADUATED FROM HIGH SCHOOL WHEN COMPARED TO THE NATION. A HIGHER PERCENTAGE OF RESIDENTS IN PERRY AND YORK COUNTIES COMPLETED THEIR EDUCATION WITH A HIGH SCHOOL DIPLOMA. RESIDENTS IN CUMBERLAND AND DAUPHIN COUNTIES ARE MORE LIKELY TO HAVE ATTAINED HIGHER EDUCATION; CUMBERLAND COUNTY EXCEEDS THE STATE AND THE NATION FOR THIS MEASURE.
PART VI, LINE 5:	IN ADDITION TO THE NET COMMUNITY BENEFIT COSTS INCURRED BY THE ORGANIZATION AS REPORTED IN SCHEDULE H, PART I, LINE 7; PLEASE REFER TO SCHEDULE O OF THIS FORM 990 FOR THE ORGANIZATION'S NARRATIVE COMMUNITY BENEFIT STATEMENT FOR ADDITIONAL INFORMATION ON HOW THE ORGANIZATION PROMOTES HEALTH AND PROVIDES HEALTHCARE SERVICES TO THE COMMUNITY REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY IN FURTHERANCE OF ITS CHARITABLE TAX EXEMPT PURPOSE.
PART VI, LINE 6:	THE HOSPITAL IS AN AFFILIATE WITHIN GEISINGER, AN INTEGRATED HEALTH SERVICES ORGANIZATION THAT INCLUDES 13 HOSPITAL CAMPUSES, A NEARLY 600,000-MEMBER HEALTH PLAN, TWO RESEARCH CENTERS, THE GEISINGER LEWISTOWN HOSPITAL SCHOOL OF NURSING AND THE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE. AND GEISINGER'S MYCODE COMMUNITY HEALTH INITIATIVE, THE LARGEST HEALTHCARE SYSTEM-BASED PRECISION HEALTH PROJECT IN THE WORLD, WITH NEARLY 200,000 VOLUNTEERS ENROLLED, IS CONDUCTING EXTENSIVE RESEARCH AND RETURNING MEDICALLY ACTIONABLE RESULTS TO PARTICIPANTS.HISTORYGEISINGER HAD ITS BEGINNINGS IN THE SMALL COMMUNITY OF DANVILLE, WHICH IS LOCATED IN CENTRAL PENNSYLVANIA ON THE NORTHERN BRANCH OF THE SUSQUEHANNA RIVER. THERE, IN 1915, ABIGAIL A. GEISINGER FOUNDED THE GEORGE F. GEISINGER MEMORIAL HOSPITAL IN MEMORY OF HER HUSBAND. FROM THE BEGINNING, THE NEW HOSPITAL WAS DESIGNED AS A COMPREHENSIVE HEALTHCARE INSTITUTION THAT WOULD OFFER SPECIALIZED MEDICAL CARE TO PEOPLE IN THE RURAL AREAS OF CENTRAL AND NORTHEASTERN PENNSYLVANIA.UNLIKE MOST HEALTHCARE SYSTEMS, WHICH EVOLVED WITH A HOSPITAL FOCUS, GEISINGER'S HISTORY AND TRADITION IS THAT OF A PHYSICIAN-LED AND PHYSICIAN-DRIVEN HEALTHCARE ORGANIZATION. THIS TRADITION BEGAN WHEN MRS. GEISINGER BROUGHT DR. HAROLD FOSS, A MAYO CLINIC TRAINED PHYSICIAN, TO BE HER HOSPITAL'S FIRST CHIEF OF STAFF. TODAY, GEISINGER IS REGARDED AS A NATIONAL MODEL OF HEALTHCARE DELIVERY CENTERED ON A SOPHISTICATED MULTISPECIALTY GROUP PRACTICE. SINCE THE 1970S, GEISINGER'S STRATEGY OF INTEGRATING PHYSICIANS AND HOSPITALS EXPANDED TO INCLUDE THE MANAGEMENT OF HEALTH AND THE FINANCING OF HEALTHCARE SERVICES THROUGH ITS WHOLLY CONTROLLED HEALTH MAINTENANCE ORGANIZATION, GEISINGER HEALTH PLAN. TWO INDEMNITY HEALTH INSURERS, GEISINGER INDEMNITY INSURANCE COMPANY AND GEISINGER QUALITY OPTIONS, INC. HAVE BEEN ADDED IN RECENT YEARS.CORPORATE STRUCTURETHE ORGANIZATIONAL STRUCTURE OF THE SYSTEM REFLECTS THE STRATEGIC GOAL OF OPERATING AS A FULLY INTEGRATED HEALTHCARE SYSTEM WHOSE CORPORATE COMPONENTS SHARE THE COMMON GOALS OF MANAGING AND IMPROVING THE HEALTHCARE OF ITS PATIENTS AND MEMBERS, WHILE RECOGNIZING AND RESPECTING THE CORPORATE IDENTITY OF EACH ENTITY. THIS INTEGRATION LINKS THE AREAS OF PHYSICIANS, HOSPITALS/CLINICS, AND HEALTHCARE INSURANCE.SEE SCHEDULE R FOR A LIST OF THE AFFILIATED ORGANIZATIONS COMPRISING GEISINGER.
PART VI, LINE 7	AT THIS TIME, THE HOSPITAL AND ITS AFFILIATES ARE NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE.

Schedule H (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

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

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? .............

Yes

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

Yes

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

Yes

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)
1DAVID J FELICIO ESQUIRE SECRETARY	(i) (ii)	0 ------------- 782,115	0 ------------- 0	0 ------------- 294,985	0 ------------- 182,465	0 ------------- 25,727	0 ------------- 1,285,292	0 ------------- 235,495
2KYLE C SNYDER MHA CAO, DIRECTOR	(i) (ii)	351,515 ------------- 0	0 ------------- 0	120,740 ------------- 0	47,230 ------------- 0	30,575 ------------- 0	550,060 ------------- 0	42,433 ------------- 0
3LENKE ERKI MD DIRECTOR	(i) (ii)	0 ------------- 443,706	0 ------------- 24,935	0 ------------- 20,849	0 ------------- 15,409	0 ------------- 25,979	0 ------------- 530,878	0 ------------- 0
4JOSEPH A TORCHIA MD CMO, HSHS	(i) (ii)	123,564 ------------- 0	0 ------------- 0	371,775 ------------- 0	8,410 ------------- 0	2,732 ------------- 0	506,481 ------------- 0	0 ------------- 0
5CHINH N PHAM MD DIRECTOR	(i) (ii)	0 ------------- 396,165	0 ------------- 28,060	0 ------------- 0	0 ------------- 12,955	0 ------------- 30,908	0 ------------- 468,088	0 ------------- 0
6THOMAS J GRIFONE MD FORMER 5 HIGHEST	(i) (ii)	0 ------------- 358,084	0 ------------- 0	0 ------------- 22,417	0 ------------- 14,179	0 ------------- 29,518	0 ------------- 424,198	0 ------------- 0
7MICHAEL J PASZEK MD FORMER 5 HIGHEST	(i) (ii)	0 ------------- 327,417	0 ------------- 0	0 ------------- 24,099	0 ------------- 18,365	0 ------------- 18,863	0 ------------- 388,744	0 ------------- 0
8JASON STANFORD PHD RTR T CMD FORMER 5 HIGHEST	(i) (ii)	0 ------------- 210,478	0 ------------- 0	0 ------------- 89,535	0 ------------- 25,030	0 ------------- 26,994	0 ------------- 352,037	0 ------------- 0
9RANDY B MORRIS TREASURER	(i) (ii)	287,453 ------------- 0	0 ------------- 0	25,736 ------------- 0	14,062 ------------- 0	21,408 ------------- 0	348,659 ------------- 0	0 ------------- 0
10AJAY K SAINI MD DIRECTOR	(i) (ii)	0 ------------- 250,337	0 ------------- 0	0 ------------- 49,095	0 ------------- 12,851	0 ------------- 29,554	0 ------------- 341,837	0 ------------- 0
11LORI R GRAMLEY ESQUIRE ASST. SECRETARY	(i) (ii)	0 ------------- 270,559	0 ------------- 0	0 ------------- 33,554	0 ------------- 19,884	0 ------------- 10,915	0 ------------- 334,912	0 ------------- 0
12PAUL D BRETTSCHNEIDER MD FORMER 5 HIGHEST	(i) (ii)	0 ------------- 262,226	0 ------------- 0	0 ------------- 16,496	0 ------------- 14,028	0 ------------- 26,980	0 ------------- 319,730	0 ------------- 0
13RICHARD SCHREIBER ASSOCIATE CIO	(i) (ii)	245,788 ------------- 0	0 ------------- 0	28,487 ------------- 0	14,595 ------------- 0	21,395 ------------- 0	310,265 ------------- 0	0 ------------- 0
14DANIEL E LOHR ESQUIRE FORMER OFFICER	(i) (ii)	0 ------------- 285,686	0 ------------- 0	0 ------------- 1,976	0 ------------- 19,884	0 ------------- 627	0 ------------- 308,173	0 ------------- 0
15ANDREW R WALKER MD FORMER 5 HIGHEST	(i) (ii)	0 ------------- 243,615	0 ------------- 0	0 ------------- 20,815	0 ------------- 12,399	0 ------------- 25,596	0 ------------- 302,425	0 ------------- 0
16GLORIA SANTOS VP, CNO	(i) (ii)	234,397 ------------- 0	0 ------------- 0	37,746 ------------- 0	7,202 ------------- 0	22,496 ------------- 0	301,841 ------------- 0	0 ------------- 0
17JAGADEESH K MOOLA MD FORMER 5 HIGHEST	(i) (ii)	0 ------------- 224,628	0 ------------- 0	0 ------------- 32,300	0 ------------- 12,051	0 ------------- 28,287	0 ------------- 297,266	0 ------------- 0
18BARBARA SUMBATIAN MD FORMER 5 HIGHEST	(i) (ii)	0 ------------- 212,105	0 ------------- 0	0 ------------- 37,521	0 ------------- 14,823	0 ------------- 19,805	0 ------------- 284,254	0 ------------- 0
19ELLEN R LENKEVICH CRNP VP, CHIEF NURSING OFFICER HSHS	(i) (ii)	244,508 ------------- 0	0 ------------- 0	5,347 ------------- 0	5,561 ------------- 0	18,715 ------------- 0	274,131 ------------- 0	0 ------------- 0
20COURTNEY K BAKER DO FORMER 5 HIGHEST	(i) (ii)	0 ------------- 185,081	0 ------------- 0	0 ------------- 21,260	0 ------------- 208	0 ------------- 9,465	0 ------------- 216,014	0 ------------- 0
21GERALD R NEWHOUSE FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 209,223	0 ------------- 0	0 ------------- 260	0 ------------- 209,483	0 ------------- 0
22JAMES A WILKEMEYER CLINICAL PHARMACIST	(i) (ii)	166,575 ------------- 0	0 ------------- 0	8,331 ------------- 0	8,698 ------------- 0	9,267 ------------- 0	192,871 ------------- 0	0 ------------- 0
23MARK E PAINTER SR. ADMIN DIRECTOR	(i) (ii)	161,007 ------------- 0	0 ------------- 0	7,780 ------------- 0	8,326 ------------- 0	10,920 ------------- 0	188,033 ------------- 0	0 ------------- 0
24BETH A THOMSON ASST. DIRECTOR, PHARM	(i) (ii)	156,503 ------------- 0	0 ------------- 0	3,884 ------------- 0	0 ------------- 0	9,673 ------------- 0	170,060 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
PART I, LINE 1	TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - FROM TIME TO TIME, THE GEISINGER BOARD OF DIRECTORS OF GEISINGER SENIOR MANAGEMENT APPROVE THE GROSS-UP OF EXPENSES, WHICH FURTHER GEISINGER BUSINESS, FOR TAX OBLIGATIONS.
PART I, LINE 4A - SEVERANCE, NONQUALIFED, AND EQUITY-BASED PAYMENTS	UPON INVOLUNTARY SEPARATION, EMPLOYEES MAY BE ELIGIBLE TO RECEIVE CONTINUATION OF SALARY FOR A TERM THAT IS BASED ON THEIR YEARS OF GEISINGER SERVICE AND POSITION. JOSEPH A. TORCHIA, MD: $357,078 SEVERANCE GERALD R. NEWHOUSE: $203,622 SEVERANCE
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. DAVID J. FELICIO, ESQUIRE: $235,495 NONQUALIFIED KYLE C. SNYDER, MHA: $42,433 NONQUALIFIED
PART I, LINE 8 - PURSUANT TO CONTRACT PER REGS. SECTION 53.4958-4(A)(3)	THE EMPLOYEES LISTED PARTICIPATE IN A COMPENSATION PROGRAM DESIGNED TO BE MARKET COMPETITIVE. FROM TIME TO TIME, DEPENDING ON THE AVAILABILITY OF QUALIFIED APPLICANTS, RECRUITMENT LOANS MAY BE MADE AVILABLE TO QUALIFIED APPLICANTS IN DIFFICULT TO RECRUIT POSITIONS. SUCH LOANS ARE ONLY PROVIDED IF TOTAL COMPENSATION, INCLUDING THE LOAN AMOUNT, IS CONSIDERED REASONABLE COMPENSATION PER INDEPENDENT SALARY SURVEYS.
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 L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

Part I

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

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

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

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

Part II

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

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No
(1) GLORIA SANTOS	KE	RECRUITMENT		X	25,000	12,117		No	Yes		Yes
(2) GLORIA SANTOS	KE	RECRUITMENT		X	25,000	7,626		No	Yes		Yes
(3) MICHAEL SERLUCO	FMR DIR	MORTGAGE	X		1,200,000	603,410		No	Yes		Yes



Total ............... $						623,153

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ALEXANDRA B POCHAK	FAMILY	62,612	COMP/BEN		No

Part V

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

Return Reference	Explanation
SCHEDULE L, PART V - ADDITIONAL INFORMATION	ALEXANDRA B POCHAK IS A FAMILY MEMBER OF RANDY B. MORRIS, AN OFFICER OF HOLY SPIRIT HOSPITAL.

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

Return Reference	Explanation
FORM 990, PART I, ORGANIZATION'S MISSION	HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY (DOING BUSINESS AS GEISINGER HOLY SPIRIT HOSPITAL), SHARES GEISINGER HOLY SPIRIT'S MISSION AS A COMMUNITY CATHOLIC HEALTH SYSTEM AND SERVES TO CARRY OUT THE HEALING MINISTRY OF JESUS CHRIST TO ALL IN NEED AND PROVIDING HIGH QUALITY, ETHICALLY-GUIDED, AND COST-EFFECTIVE HEALTH SERVICES IN A CARING, PATIENT-FOCUSED ENVIRONMENT TO DEVELOP HEALTH COMMUNITIES IN THE GRATER HARRISBURG AREA AND SOUTH CENTRAL PENNSYLVANIA.
CONTINUATION PART III PROGRAM SERV ACCOMPLISHMENTS	THE BIRTHPLACE AND NICU NURSES THE BIRTHPLACE AT GEISINGER HOLY SPIRIT IS EQUIPPED TO MEET THE NEEDS OF MEN DURING AND AFTER BABIES ARRIVE. A VARIETY OF SERVICES ARE OFFERED IN A COMFORTABLE AND WARM ENVIRONMENT WITH A TEAM OF SPECIALLY-TRAINED NURSES WHO PROVIDE CARE TO EACH MOM AND BABY DURING LABOR, DELIVERY, AND RECOVERY. THE NEONATAL INTENSIVE CARE UNIT (NICU) IS STAFFED BY SOME OF THE AREA'S MOST WELL-RESPECTED NEONATOLOGISTS, READY TO ASSIST PHYSICIANS OR MIDWIVES WITH BABIES' MEDICAL NEEDS. THE NICU OFFERS LEVEL III CARE ONSITE, WHICH MEANS TODAY'S MOST ADVANCED MEDICAL TECHNOLOGY IS CLOSE AT HAND TO DEAL WITH ANY SPECIAL NEEDS. STAFF MEMBERS HAVE CARED FOR BABIES AS YOUNG AS 27-28-WEEKS' GESTATION AND OTHER BABIES WHO NEED INTENSIVE CARE. SEXUAL ASSAULT NURSES CARING PROPERLY FOR INDIVIDUALS WHO ARE VICTIMS OF SEXUAL VIOLENCE AND PROVIDING A POSITIVE EXPERIENCE IN THE HOSPITAL SETTING CAN CONTRIBUTE GREATLY TO THE HEALING PROCESS. TO ENSURE DIGNITY AND COMPASSION, THE EMERGENCY DEPARTMENT HAS A DEDICATED EXAMINATION ROOM EQUIPPED WITH THE LATEST FORENSIC TECHNOLOGY. A TEAM OF NURSES TRAINED AS SEXUAL ASSAULT NURSE EXAMINERS (SANE CERTIFIED) COLLECT MEDICAL AND LEGAL EVIDENCE, WHILE BEING SENSITIVE AND EMPATHETIC TO PATIENT NEEDS. STUDENT NURSES GEISINGER HOLY SPIRIT STAFF FACILITATED CLINICAL EXPERIENCES FOR UNDERGRADUATE AND GRADUATE NURSING STUDENTS FROM THE FOLLOWING SCHOOLS: HARRISBURG AREA COMMUNITY COLLEGE, MESSIAH COLLEGE, PENN STATE UNIVERSITY HARRISBURG, PENN STATE UNIVERSITY MONT ALTO, PENN STATE UNIVERSITY HERSHEY, YORK COLLEGE, WIDENER UNIVERSITY, DUQUESNE UNIVERSITY, LOCK HAVEN UNIVERSITY, SPRING ARBOR UNIVERSITY, CHAMBERLAIN COLLEGE OF NURSING, GEISINGER LEWISTOWN HOSPITAL SCHOOL OF NURSING, UNIVERSITY OF SOUTH ALABAMA, MILLERSVILLE UNIVERSITY, HERZING UNIVERSITY, MARYVILLE UNIVERSITY, SIMMONS COLLEGE, AND WIDENER UNIVERSITY. UNCOMPENSATED CARE HOLY SPIRIT HOSPITAL RECOGNIZES THAT ITS MISSION IS TO SERVE ALL THE MEMBERS OF THE COMMUNITY WITH RESPECT TO THE PROVISION OF HEALTHCARE SERVICES AND EDUCATION. HOLY SPIRIT HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN THIS REGARD, HOLY SPIRIT HOSPITAL PROVIDES FREE OR SUBSIDIZED CARE BELOW COST AND SUPPORTS VARIOUS HEALTH ACTIVITIES AND PROGRAMS IN SUPPORT OF THE COMMUNITY. CHARITY CARE THE PRIMARY CONCERN OF HOLY SPIRIT HOSPITAL IS THE DELIVERY OF HEALTH CARE TO ALL THE CITIZENS OF THE GREATER HARRISBURG AREA AND SOUTH-CENTRAL PENNSYLVANIA, REGARDLESS OF THEIR ABILITY TO PAY. THE UNREIMBURSED COST OF CHARITY CARE REPRESENTS THE COST HOLY SPIRIT HOSPITAL INCURS BY PROVIDING FREE OR DISCOUNTED SERVICES TO THOSE WHO CANNOT AFFORD TO PAY. THE COST TO HOLY SPIRIT HOSPITAL OF PROVIDING THIS CHARITY CARE DURING THE FISCAL YEAR WAS $4,446,792. MEDICARE/MEDICAID/OTHER GOVERNMENTAL RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO THE ELDERLY (MEDICARE), THE POOR (MEDICAID) AS WELL AS OTHERS. HOLY SPIRIT HOSPITAL PROVIDES CARE, BELOW COST, TO PERSONS COVERED BY THESE GOVERNMENTAL PROGRAMS. TO THE EXTENT REIMBURSEMENT IS BELOW THE COST OF PROVIDING HEALTHCARE, HOLY SPIRIT HOSPITAL IS FURTHERING ITS MISSION TO THE ENTIRE COMMUNITY. THE UNREIMBURSED VALUE OF MEDICARE AND/OR MEDICAID AND/OR OTHER GOVERNMENTAL PAYERS IS EQUAL TO THE COST OF PROVIDING SERVICES LESS THE AMOUNT RECEIVED AS REIMBURSEMENT UNDER THE PROGRAM. FOR FISCAL YEAR, THE UNREIMBURSED COST OF PROVIDING CARE TO THESE PATIENTS WAS $51,774,783. OTHER UNCOMPENSATED PATIENT SERVICES IN ADDITION, HOLY SPIRIT HOSPITAL PROVIDES OTHER PATIENT SERVICES FOR WHICH FULL PAYMENT IS NOT RECEIVED. THE UNCOMPENSATED COST OF PROVIDING SUCH PATIENT SERVICES DURING THE FISCAL YEAR WAS $1,823,667. HEALTH PROFESSIONS EDUCATION HSH CONDUCTS ONE GRADUATE MEDICAL EDUCATION RESIDENCY PROGRAM. THERE WERE TWO GRADUATE PHYSICIANS PARTICIPATING IN THIS PROGRAM DURING THE FISCAL YEAR. THE PROGRAM SPECIALTY IS GENERAL SURGERY. THE TOTAL COST TO HSH OF PROVIDING RESIDENCY EDUCATION PROGRAM, NET OF THIRD-PARTY REIMBURSEMENTS WAS $652,995. COMMUNITY HEALTH, EDUCATION AND OUTREACH HOLY SPIRIT HOSPITAL STRIVES TO SERVE AS A PARTNER TO OUR LOCAL COMMUNITY AND RESIDENTS. HOLY SPIRIT HOSPITAL PROVIDES CARE TO THE COMMUNITY THROUGH MANY REDUCED-PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH HOLY SPIRIT HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. THESE SERVICES AND PROGRAMS WERE PROVIDED AT A COST OF $324,447 DURING THE FISCAL YEAR. COMMUNITY BENEFIT SUMMARY CHARITY CARE $ 4,446,792 MEDICARE/MEDICAID/OTHER GOVERNMENTAL 51,774,783 OTHER UNCOMPENSATED PATIENT SERVICES 1,823,667 HEALTH PROFESSIONS EDUCATION 652,995 COMMUNITY HEALTH, EDUCATION, OUTREACH AND OTHER 324,447 TOTAL COMMUNITY SERVICE $ 59,022,684 STATISTICS - HOLY SPIRIT HOSPITAL FISCAL YEAR ENDED JUNE 30, 2020 DISCHARGES 11,159 OCCUPANCY 41.9% LENGTH OF STAY 4.5 OUTPATIENT VISITS 228,991 OUTPATIENT EMERGENCY CARE VISITS 28,722 SURGICAL PROCEDURES 6,760 BIRTHPLACE DELIVERIES 1,059 SUBSEQUENT EVENTS EFFECTIVE NOVEMBER 1, 2020, GEISINGER TRANSFERRED ITS MEMBERSHIP OF HOLY SPIRIT HEALTH SYSTEM AND AFFILIATES (HOLY SPIRIT HOSPITAL, HOLY SPIRIT CORPORATION, SPIRIT PHYSICIAN SERVICES) TO PENN STATE HEALTH.
FORM 990, PART IV, LINE 24A:	GEISINGER HEALTH (GH) IS CURRENTLY THE SOLE OBLIGOR UNDER A SERIES OF BOND ISSUES, INCLUDING TAX-EXEMPT BONDS ISSUED PRIOR TO DECEMBER 31, 2002, WITH A TOTAL OUTSTANDING BALANCE AT JUNE 30, 2020 OF $1,958,191,188, INCLUSIVE OF UNAMORTIZED ORIGINAL ISSUE DISCOUNT. BECAUSE THE BOND PROCEEDS ARE DISBURSED TO GH SUBSIDIARIES, THE TAX-EXEMPT BOND LIABILITIES ARE REFLECTED ON THE BALANCE SHEETS OF THE FOLLOWING SUBSIDIARY ORGANIZATIONS: GEISINGER MEDICAL CENTER; EIN: 24-0795959 GEISINGER WYOMING VALLEY MEDICAL CENTER; EIN: 23-1996150 GEISINGER CLINIC; EIN: 23-6291113 MARWORTH; EIN: 23-2171417 GEISINGER SYSTEM SERVICES; EIN: 23-2164794 COMMUNITY MEDICAL CENTER; EIN: 24-0862246 GEISINGER-BLOOMSBURG HOSPITAL; EIN: 23-2193572 GEISINGER-LEWISTOWN HOSPITAL; EIN: 23-1352187 HOLY SPIRIT HOSPITAL; EIN: 23-1512747 GEISINGER COMMONWEALTH SCHOOL OF MEDICINE; EIN: 26-0812968 GEISINGER JERSEY SHORE HOSPITAL; EIN: 24-0792115 ATLANTICARE REGIONAL MEDICAL CENTER; EIN: 21-0634549 SCHEDULE K WAS PREPARED ON A CONSOLIDATED BASIS AND IS INCLUDED IN THE FORM 990 FILING OF GEISINGER HEALTH, EIN: 23-1995911.
FORM 990, PART V, LINE 1A:	GEISINGER SYSTEM SERVICES (GSS), AN AFFILIATE OF THE ORGANIZATION, PROVIDES A CENTRALIZED ACCOUNTS PAYABLE FUNCTION FOR ALL GEISINGER ORGANIZATIONS. AS THE ACCOUNTS PAYABLE PROCESSOR, GSS PREPARES AND FILES FORM 1099 UNDER ITS EIN FOR ALL REPORTABLE PAYMENTS OF THE FILING ORGANIZATION. THE NUMBER OF FORM 1099'S FILED BY GSS FOR THE 2019 REPORTING PERIOD ON BEHALF OF ITSELF AND ITS AFFILIATES WAS 1,633. THE RESPONSE ENTERED ON LINE 1A FOR THE ORGANIZATION INCLUDES ONLY THOSE FORM 1099S FILED UNDER THE ORGANIZATIONS EIN. IT DOES NOT INCLUDE THOSE FILED BY GSS ON ITS BEHALF.
FORM 990, PART VI, SECTION A, LINE 2	BUSINESS RELATIONSHIPS: AJAY K. SAINI, MD, CHINH N. PHAM, MD, CHRISTOPHER MOYER, DO, DAVID J. FELICIO, ESQUIRE, DEBORAH KEYS, HANK STRAUB, KYLE C. SYNDER, MHA, LAUIRE SALTZGIVER, ESQUIRE, LENKE ERKI, MD, LORI J. GRAMLEY, ESQUIRE, NORA HABIG, RANDY B. MORRIS, REVEREND DAVID DANNEKER, REVEREND ROBERT F. SHARMAN, RON DRNEVICH, SISTER JOANN MARIE AUMAND, SCC, AND SISTER MARIE PAULINE DEMEK, SCC 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, PART VI, SECTION A, LINE 6	GEISINGER HEALTH SERVES AS THE SOLE CORPORATE MEMBER OF HOLY SPIRIT HEALTH SYSTEM AND HOLY SPIRIT HEALTH SYSTEM SERVICES AS CORPORATE MEMBER FOR HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY, SPIRIT PHYSICIAN SERVICES, INC., HOLY SPIRIT CORPORATION AND SOLE SHAREHOLDER OF HOLY SPIRIT VENTURES INC. THE MEMBERS OF THE CORPORATION HAVE THE POWER AND AUTHORITY TO ELECT AND REMOVE THE DIRECTORS; ELECT AND REMOVE THE PRESIDENT AND FILL ANY VACANCY IN THE OFFICE OF THE PRESIDENT OF THE CORPORATION; AND, MAY APPROVE AMENDMENTS TO THE CORPORATE BYLAWS IN LIEU OF SUCH APPROVAL BY THE BOARD OF DIRECTORS. THE MEMBERS ALSO HAVE THE RESERVE POWERS AS SET FORTH IN THE PENNSYLVANIA NONPROFIT CORPORATION LAW.
FORM 990, PART VI, SECTION A, LINE 7A	THE BOARD OF DIRECTORS OF THE CORPORATION SHALL SERVE AS THE GOVERNING BODY OF THE CORPORATION. THE PRESIDENT OF THE CORPORATION SHALL BE A DIRECTOR BY REASON OF HOLDING SUCH OFFICE. THE REMAINING DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. THE MEMBERS OF THE COPRORATION MAY SERVE AS DIRECTORS AND DIRECTORS MAY SUCCEED THEMSELVES FROM TERM TO TERM. VACANCIES ON THE BOARD OF DIRECTORS SHALL BE FILLED BY THE MEMBERS AT THEIR DISCRETION AT THE ANNUAL MEETING OF THE MEMBERS OR AT A SPECIAL MEETING CALLED FOR SUCH PURPOSE.
FORM 990, PART VI, SECTION B, 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 OR DIRECTOR'S FINANCE COMMITTEE CHARTER, GEISINGER ORGANIZATIONS' FORM 990 FILINGS ARE REVIEWED ANNUALLY. THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM 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 AVAIALBE 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 REVEIW ALL FEDERAL TAX RETURNS FILED BY GEISIGNER 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 THE REPORTING PERIOD.
FORM 990, PART VI, SECTION B, LINE 12C	THE OFFICERS AND DIRECTORS OF THE ORGANIZATION ARE SUBJECT TO THE GEISINGER CONFLICT OF INTEREST POLICY FOR DIRECTORS AND OFFICERS. 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 AFFILITATE WITHIN GEISINGER. THE DISCLOSURES ARE REVIEWED BY THE COMPLIANCE OFFICE AND THE CHIEF LEGAL OFFICER AND REPORTED TO THE AUDIT AND COMPLAINCE COMMITTEES AND BOARDS OF DIRECTORS. AFTER REVIEW OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, INPUT FROM THE COMPLIANCE OFFICE AND THE 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, PART VI, SECTION B, LINE 15	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 FMAILY 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 THRID 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, PART VI, SECTION C, 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-RE PORTS. 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 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 VOTING MEMBERS ARE NOT INDEPENDENT BECAUSE THREE ARE COMPENSATED AS EMPLOYEES OF RELATED TAX-EXEMPT ORGANIZATIONS AND THE OTHER IS CAO OF THE ORGANIZATION.
FORM 990, PART VIII, LINE 2B:	IC SUPPORT SERVICE REVENUE REPORTED WITHIN THE LINE 2B REVENUE REPRESENTS REVENUE FROM INTERCOMPANY MANAGEMENT, ADMINISTRATIVE, AND CONSULTING SERVICES PROVIDED TO RELATED TAXABLE ORGANIZATIONS. THE ORGANIZATION AND RELATED TAXABLE ORGANIZATIONS ARE ALL CONTROLLED BY GEISINGER HEALTH. THE SERVICES, PROVIDED AT OR BELOW COST, ARE PERFORMED WITHOUT A PROFIT MOTIVE TO PROMOTE THE EFFICIENT OPERATION OF GEISINGER IN CARRYING OUT ITS CHARITABLE MISSION. THE SERVICES ARE NOT OFFERED TO UNRELATED ORGANIZATIONS OR TO THE GENERAL PUBLIC. UNDER IRS ADVISORY DATED MARCH 7, 2014, THESE INTERCOMPANY SHARED SERVICES ARE NOT INCLUDED IN THE DEFINITION OF UNRELATED BUSINESS INCOME AND SHOULD NOT BE INCLUDED ON FORM 990-T DUE TO THE ABSENCE OF THE FOLLOWING TWO CONDITIONS: (1) THE SERVICES MUST BE ABOVE COST OR AT FAIR MARKET VALUE, AND (2) THERE MUST BE A PROFIT MOTIVE.
FORM 990, PART IX, LINE 11G	OTHER SERVICES: PROGRAM SERVICE EXPENSES 28,387,716. MANAGEMENT AND GENERAL EXPENSES 2,038,853. TOTAL EXPENSES 30,426,569.
FORM 990, PART IX, LINE 24	LINE 24E CONTAINS UNRELATED BUSINESS INCOME TAX REFUND RECEIVED OF $137,434.
FORM 990, PART XI, LINE 9:	TRANSFERS TO/FROM AFFILIATE(S) 6,000,000. NET ASSETS RELEASED FOR EQUIPMENT PURCHASE 4,154,232. NET ASSETS RELEASED FROM RESTRICTION-FUND OPERATIONS -792,146. NET ASSETS RELEASED FROM RESTRICTION-EQUIPMENT PURCH -4,005,309.

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

HOLY SPIRIT HOSPITAL OF THE SISTERS
OF CHRISTIAN CHARITY

Employer identification number

23-1512747

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 DANVILLE,PA17822 23-1995911	PHILANTHROPY	PA	501(C)(3)	LINE 7	N/A		No
(2)GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 24-0795959	HOSPITAL	PA	501(C)(3)	LINE 3	GH		No
(3)GEISINGER CLINIC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-6291113	PHYSN SVCS	PA	501(C)(3)	LINE 12A, I	GH		No
(4)GEISINGER WYOMING VALLEY MED CTR 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-1996150	HOSPITAL	PA	501(C)(3)	LINE 3	GH		No
(5)MARWORTH 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2171417	D&A REHAB	PA	501(C)(3)	LINE 3	GH		No
(6)GEISINGER HEALTH PLAN 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2311553	HMO	PA	501(C)(4)		GH		No
(7)GEISINGER SYSTEM SERVICES 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2164794	SUPPORT SV	PA	501(C)(3)	LINE 12A, I	GH		No
(8)GEISINGER COMMUNITY HEALTH SERVICES 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2967235	HEALTHCARE	PA	501(C)(3)	LINE 10	GSS		No
(9)GEISINGER INSURANCE CORPORATION RRG 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 14-1909894	SELF INS	VT	501(C)(3)	LINE 12A, I	GH		No
(10)COMMUNITY MEDICAL CENTER 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 24-0862246	HOSPITAL	PA	501(C)(3)	LINE 3	GH		No
(11)MOUNTAIN VIEW NURSING HOME INC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2568288	LNGTM CARE	PA	501(C)(3)	LINE 10	GH		No
(12)GEISINGER-BLOOMSBURG HOSPITAL 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2193572	HOSPITAL	PA	501(C)(3)	LINE 3	GH		No
(13)GEISINGER-BLOOMSBURG HEALTHCARE CTR 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2242854	SKILLED NU	PA	501(C)(3)	LINE 10	GH		No
(14)GEISINGER LEWISTOWN HOSPITAL 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-1352187	HOSPITAL	PA	501(C)(3)	LINE 3	GH		No
(15)LEWISTOWN AMBULATORY CARE CORP 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2344362	HOLDING CO	PA	501(C)(3)	LINE 12A, I	GH		No
(16)FAMILY HEALTH ASSOCIATES OF GLH 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 25-1651582	PHYSN SVCS	PA	501(C)(3)	LINE 12A, I	GH		No
(17)KEYSTONE HEALTH INFORMATION EXCH 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 46-4359893	RHIO	PA	501(C)(3)	LINE 12A, I	GH		No
(18)HEALTH CARE CORP OF NORTHEAST PA 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2337286	SUPPORT SV	PA	501(C)(3)	LINE 12A, I	CMC		No
(19)HOLY SPIRIT CORPORATION 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2214540	HOLDING CO	PA	501(C)(2)		HSHS		No
(20)SPIRIT PHYSICIAN SERVICES INC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 25-1766971	PHYSN SVCS	PA	501(C)(3)	LINE 10	HSHS	Yes
(21)WEST SHORE ADVANCED LIFE SUPPORT SERVICES 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2463002	HEALTHCARE	PA	501(C)(3)	LINE 10	GC		No
(22)GEISINGER COMMONWEALTH SCH OF MED 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2463002	EDUCATION	PA	501(C)(3)	LINE 2	GH		No
(23)GEISINGER JERSEY SHORE HOSPITAL 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 24-0792115	HOSPITAL	PA	501(C)(3)	LINE 3	GH		No
(24)GEISINGER JERSEY SHORE HOSPITAL FND 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2480603	HEALTHCARE	PA	501(C)(3)	LINE 3	GH		No
(25)GSL HOSPITAL 801 OSTRUM STREET BETHLEHEM,PA18015 82-4432109	HOSPITAL	PA	501(C)(3)	LINE 3			No
(26)GSLPG INC 801 OSTRUM STREET BETHLEHEM,PA18015 82-5423865	HEALTHCARE	PA	501(C)(3)	LINE 3	GSL HOSP		No
(27)ATLANTICARE BEHAVORIAL HEALTH INC 2511 FIRE ROAD EGG HARBOR TOWNSHIP,NJ08234 21-0721208	HEALTHCARE	NJ	501(C)(3)	LINE 7	ARHS		No
(28)ATLANTICARE FOUNDATION INC 6725 DELILAH ROAD EGG HARBOR TOWNSHIP,NJ08234 22-2148992	SUPPORT AR	NJ	501(C)(3)	LINE 7	AH SYSTEM		No
(29)ATLANTICARE HEALTH ENGAGEMENT INC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 61-1608389	HEALTHCARE	NJ	501(C)(3)	LINE 12A, I	AH SYSTEM		No
(30)ATLANTICARE HEALTH SERVICES INC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 22-3265214	HEALTHCARE	NJ	501(C)(3)	LINE 10	ARHS		No
(31)ATLANTICARE HEALTH SYSTEM INC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 22-3265213	SUPPORT AR	NJ	501(C)(3)	LINE 12A, I	GH		No
(32)ATLANTICARE REGIONAL MEDICAL CENTER 1925 PACIFIC AVENUE ATLANTIC CITY,NJ08401 21-0634549	HOSPITAL	NJ	501(C)(3)	LINE 3	ARHS		No
(33)ATLANTICARE PHYSICIAN GROUP PA 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 02-0701782	HEALTHCARE	NJ	501(C)(3)	LINE 12A, I	AH SYSTEM		No
(34)ATLANTICARE REGIONAL HEALTH SERVICE 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 80-0834222	HOSPITAL	NJ	501(C)(3)	LINE 12A, I	AH SYSTEM		No
(35)COOPERATIVE HOME HLTH CARE ATL CNTY 6550 DELILAH ROAD SUITE 304 EGG HARBOR TOWNSHIP,NJ08234 23-3836022	HOME HEALTH	NJ	501(C)(3)	LINE 10	AH SYSTEM		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 DANVILLE,PA17822 45-5484165	ACO	PA						No			No
(2) LIFESOURCE GEISINGER BLOOD CTR LLC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 36-4718005	BLOOD COLL.	PA						No			No
(3) GEISINGER ENCOMPASS HEALTH LLC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 72-1398803	PHY THERAPY	PA						No			No
(4) EVANGELICAL-GEISINGER HEALTH LLC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 46-0567687	HEALTHCARE	PA						No			No
(5) LEMED II 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2391766	RENTAL	PA						No			No
(6) GEISINGER-SCA HOLDINGS LLC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 46-1615328	MANAGEMENT	DE						No			No
(7) CAMP HILL AMBULATORY CENTERS 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM,PA35209 52-1597478	HEALTHCARE	PA	HSH	RELATED	394,907	1,856,499		No		Yes		51.000 %
(8) GRANDVIEW SURGERY CENTER LTD 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM,AL35209 52-1597483	HEALTHCARE	PA						No			No
(9) LACAKWANNA PHYS AMB SURG CTR LLC 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM,AL35209 23-3024998	HEALTHCARE	PA						No			No
(10) SOUTHERN JERSEY ONCOLOGY PROPERTIES 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 94-3463625	HEALTHCARE	NJ						No			No
(11) ATLANTICARE SURGERY CENTER LLC 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 22-3491867	HEALTHCARE	NJ						No			No
(12) COOPERATIVE HEALTH SRVS OF S JERSEY 1301 ATLANTIC AVENUE ATLANTIC CITY,NJ08401 22-3619231	PURCHASING	NJ						No			No
(13) GEISINGER-HM JOINT VENTURE LLC 1301 ATLANTIC AVENUE ATLANTIC CITY,PA08401 83-1871064	HEALTHCARE	PA						No			No
(14) KEYSTONE HEALTHCARE PARTNERSHIP LLC 901 HUGH WALLIS ROAD LAFAYETTE,PA70508 83-3134941	HOME HLTH	PA						No			No
(15) SOUTHERN JERSEY MEDICAL PROPERTIES 2500 ENGLISH CREEK AVENUE EGG HARBOR TOWNSHIP,NJ08234 38-3830843	REAL ESTATE	NJ						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 DANVILLE,PA17822 23-2077663	HOTEL/REST	PA		C				No
(2) GIESINGER INDEMINTY INSURANCE CO 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2815174	HLTH INSUR	PA		C				No
(3) GIESINGER QUALITY OPTIONS INC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 20-4275139	HLTH INSUR	PA		C				No
(4) XG HEALTH SOLUTIONS INC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 46-1657345	CONSULTING	DE		C				No
(5) HOLY SPIRIT VENTURES INC 100 NORTH ACADEMY AVENUE DANVILLE,PA17822 23-2407709	MED. SERV.	PA		C				No
(6) ATLANTICARE HEALTH SOLUTIONS INC 2500 ENGLISH CREEK AVENUE BLDG 500 EGG HARBOR TOWNSHIP,NJ08234 38-3856295	ACO/HEALTH	NJ		C				No
(7) ATLANTICARE ASSURANCE ALLIANCE INC 2500 ENGLISH CREEK AVENUE BLDG 500 EGG HARBOR TOWNSHIP,NJ08234 46-3730123	HEALTHCARE	NJ		C				No
(8) GNJ PHYICIANS GROUP PC 2500 ENGLISH CREEK AVENUE BLDG 500 EGG HARBOR TOWNSHIP,NJ08234 82-0681884	PHYSIC SVC	NJ		C				No
(9) GEISINGER ASSURANCE COMPANY LTD 23 LINE TREE BAY AVE PO BOX 1159 GRAND CAYMAN KY1- CJ 98-1016737	INSURANCE	CJ		C				No
(10) ENGLISH CREEK ASSURANCE LTD 44 CHURCH STREET HM 12 HAMILTON BERMUDA BD 98-0656394	FINANCIAL	BD		C				No

Schedule R (Form 990) 2019

Page 3

Part V

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

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

Yes

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

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

Yes

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

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

Yes

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

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

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) SPIRIT PHYSICIAN SERVICES INC	A	245,678	GAAP
(2) GEISINGER HEALTH	B	6,148,923	GAAP
(3) HOLY SPIRIT CORPORATION	K	742,887	GAAP
(4) HOLY SPIRIT VENTURES	K	478,126	GAAP
(5) GEISINGER CLINIC	L	404,417	GAAP
(6) GEISINGER COMMUNITY MEDICAL CENTER	L	370	GAAP
(7) GEISINGER HEALTH PLAN	L	16,602,334	GAAP
(8) GEISINGER JERSEY SHORE HOSPITAL	L	1,347	GAAP
(9) GEISINGER LEWISTOWN HOSPITAL	L	9,780	GAAP
(10) GEISINGER MEDICAL CENTER	L	5,932	GAAP
(11) GEISINGER SYSTEM SERVICES	L	1,165	GAAP
(12) GEISINGER WYOMING VALLEY	L	268	GAAP
(13) HOLY SPIRIT CORPORATION	L	14,635	GAAP
(14) HOLY SPIRIT HEALTH SYSTEM	L	10,941	GAAP
(15) HOLY SPIRIT VENTURES	L	14,635	GAAP
(16) SPIRIT PHYSICIAN SERVICES INC	L	270,932	GAAP
(17) GEISINGER ASSURANCE COMPANY LTD	M	1,675,162	GAAP
(18) GEISINGER CLINIC	M	1,976,834	GAAP
(19) GEISINGER HEALTH	M	477,824	GAAP
(20) GEISINGER LEWISTOWN HOSPITAL	M	300	GAAP
(21) GEISINGER MEDICAL CENTER	M	3,962,895	GAAP
(22) GEISINGER SYSTEM SERVICES	M	22,238,829	GAAP
(23) GEISINGER WYOMING VALLEY	M	1,410	GAAP
(24) HOLY SPIRIT HEALTH SYSTEM	M	254,423	GAAP
(25) ISS SOLUTIONS INC	M	6,104,586	GAAP
(26) SPIRIT PHYSICIAN SERVICES INC	M	18,861,885	GAAP
(27) WEST SHORE ADVANCED LIFE SUPPORT	M	234,086	GAAP
(28) GEISINGER INSURANCE CORPORATION RISK RETENTION GROUP	P	16,800	GAAP
(29) GEISINGER HEALTH	R	10,336	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

FORM 990, SCHEDULE R, PART V - TRANSACTIONS WITH RELATED ORGANIZATIONS

AS SHOWN IN FORM 990, SCHEDULE R, THE HOLY SPIRIT HOSPITAL IS CLOSELY AFFILIATED WITH SEVERAL OTHER ORGANIZATIONS. IN THE NORMAL COURSE OF THE OPERATIONS OF THESE AFFILIATED ORGANIZATIONS THERE ARE NUMBEROUS INTER-ORGANIZATIONAL TRANSACTIONS, WHICH MAY INCLUDE SALES, EXCHANGES, AND LEASES OR 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 ORGANIZATION'S 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: PROVIDES HEALTH SERVICES IN THE GREATER HARRISBURG AREA AND SOUTH CENTRAL PA.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	2,009
6	Total number of volunteers (estimate if necessary) .............	6	123
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	764,316
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	810

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	402,023	14,670
9	Program service revenue (Part VIII, line 2g) .........	314,552,232	320,273,050
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	318,286	919,010
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,457,445	4,981,329
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	317,729,986	326,188,059
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	124,379,249	122,110,150
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	164,625,503	173,950,626
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	289,004,752	296,060,776
19	Revenue less expenses. Subtract line 18 from line 12.......	28,725,234	30,127,283
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	112,020,267	95,423,962
21	Total liabilities (Part X, line 26).............	161,318,643	108,756,493
22	Net assets or fund balances. Subtract line 21 from line 20.....	-49,298,376	-13,332,531

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 241,274,625 including grants of $ ) (Revenue $ 319,585,510 )
	PATIENT CARE SERVICES:PATIENT CARE SERVICES IS DRIVEN BY THE HOSPITAL'S MISSION, VISION, AND VALUES (MVV). THE MVV ELEMENTS ARE AN ESSENTIAL COMPONENT TO PROVIDE HIGHLY SKILLED, COMPETENT, AND COMPASSIONATE NURSING CARE AT THE BEDSIDE AND TO FULFILL OUR NURSES' COMMITMENT TO EXCELLENCE IN CLINICAL PRACTICE, EDUCATION, AND NURSING RESEARCH.AWARDS AND RECOGNITIONGEISINGER HOLY SPIRIT HOSPITAL MAINTAINED MULTIPLE QUALITY AWARDS IN 2019. HIGHMARK AWARDS INCLUDE: HIGHMARK BLUE SHIELD, DESIGNATED BLUE DISTINCTION CENTER FOR CARDIAC CARE, BLUE DISTINCTION CENTER+ FOR KNEE AND HIP REPLACEMENT, BLUE DISTINCTION CENTER FOR MATERNITY CARE, BLUE DISTINCTION CENTER FOR SPINE SURGERY. AMERICAN HEART ASSOCIATION AWARDS INCLUDE GOLD 2019 "GET WITH THE GUIDELINES" FOR AFIB, GOLD PLUS 2019 "GET WITH THE GUIDELINES" FOR HEART FAILURE AND STROKE, AND GOLD PLUS 2018 RECEIVING "MISSION: LIFELINE". AWARDED BY THE JOINT COMMISSION IS THE NATIONAL QUALITY APPROVAL FOR ADVANCED CERTIFICATION IN INPATIENT DIABETES CARE AND PRIMARY STROKE CARE. AWARDED BY THE AMERICAN COLLEGE OF CARDIOLOGY IS THE CHEST PAIN CENTER ACCREDITED PRIMARY PCI WITH RESUSCITATION. OTHER AWARDS INCLUDE THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS (NAPBC) A QUALITY PROGRAM OF THE AMERICAN COLLEGE OF SURGEONS ACCREDITED BREAST CENTER, AND NURSES IMPROVING CARE FOR HEALTHSYSTEM ELDERS (NICHE) AS A NICHE DESIGNATED HOSPITAL. NEW FOR 2019 IS THE AMERICAN COLLEGE OF SURGEONS AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY ACCREDITATION (MBSAQIP).PRESENTATIONSREGISTERED NURSES IN PATIENT CARE SERVICES AND CLINICAL EDUCATION PROVIDED PRESENTATIONS IN HOUSE, AT PROFESSIONAL CONFERENCES, AND AT VARIOUS OTHER VENUES. IN HOUSE PRESENTATIONS: TRAUMATIC BRAIN INJURY SESSION 1 - PRESENTED BY LAUREN MCNAUGHTON MSN, RN, CCRN, HHP TRAUMATIC BRAIN INJURY SESSION 2 - PRESENTED BY LAUREN MCNAUGHTON MSN, RN, CCRN, HHP TRAUMATIC BRAIN INJURY SESSION 3 - PRESENTED BY LAUREN MCNAUGHTON MSN, RN, CCRN, HHP TRAUMATIC BRAIN INJURY SESSION 4 - PRESENTED BY LAUREN MCNAUGHTON MSN, RN, CCRN, HHP SEPSIS MAKING THE PIECES FIT PRESENTED MONTHLY IN NURSING ORIENTATION BY MARYANN M. BROGDEN-BRANDT, ND, MSN, RN, APN-C, CCNS, SCRN, CRITICAL CARE CLINICAL NURSE SPECIALIST/STROKE & SEPSIS COORDINATOR NIH STROKE SCALE DO YOU SEE WHAT I SEE PRESENTED BY MARYANN M. BROGDEN-BRANDT, ND, MSN, RN, APN-C, CCNS, SCRN, CRITICAL CARE CLINICAL NURSE SPECIALIST/STROKE & SEPSIS COORDINATOR ON 4/25/19; 4/30/19; 5/3/19; 5/23/19; AND 5/24/19 STRESS MANAGEMENT AND AROMATHERAPY, NURSING SELF CARE (4/15/19) - PRESENTED BY LAUREN MCNAUGHTON, MSN, RN, CCRN, HHP MANAGING PATIENT WITH COMORBID PSYCHIATRIC ILLNESS AT HOME (7/18/18) PRESENTED BY MARY ROCK, DNP, CRNP, FNP, CNS MANAGING TRAUMA AND LOSS (5/14/19) - PRESENTED BY JODY BRANDT, MSW, LSW; AND PATRICIA VOGL, MSW, LSW CORE ESSENTIALS PROGRAM (9/12, 9/19, 9/26, 10/3, 10/24, 10/31, 11/14) PRESENTED BY DEBORAH AUDETTE DNP, RN, ACNS-BC, CCRN-CSC, ANN HENDRICKSON, MS, RN, ACNS-BC AND MARYANN BROGDEN-BRANDT, ND, MSN, RN, APN-C, CCNS, SCRN ESSENTIAL OILS: CLINICAL SIGNIFICANCE IN ACUTE AND CRITICAL CARE (9/27/18; 10/24/18) PRESENTED BY LAUREN MCNAUGHTON, MSN, RN, CCRN, HHP CORE ESSENTIALS PROGRAM - DEBORAH AUDETTE, DNP, RN, ACNS-BC, CCRN, CSC, & MELANIE DUFFY MSN, RN, CCRN, CCNS - PRESENTATION ON EVIDENCE-BASED PRACTICE IN COLLABORATION WITH MESSIAH COLLEGE SENIOR NURSING RESEARCH CLASS AND GHS RNS WHO WORKED WITH GROUPS OF SENIOR NURSING STUDENTS TO IDENTIFY PI ISSUE, PICO QUESTION, RESEARCH, AND RECOMMENDATIONS TOTAL OF 9 CLASSES IN 2018: 9/12, 9/19, 9/26, 10/10, 10/24, 10/31, 11/7, 11/14, AND 12/12. DELIRIUM PROTOCOL BUNDLE PILOT ON 6 ORTHO - ANN HENDRICKSON MS, RN, ACNS-BC DELIRIUM AND ITS RISK FACTORS: AN EDUCATIONAL MODULE PRESENTATION TO 6 ORTHO AND 6 MAIN STAFF FOR PILOT ON DELIRIUM PROTOCOL BUNDLE 5/29/2019; 5/30/2019; 6/1/2019; 6/2/2019; AND 6/3/2019 TOTAL OF 12 PRESENTATIONS. CORE ESSENTIALS PRESENTATION AUGUST, 2018 - DEBORAH AUDETTE, DNP, RN, ACNS-BC, CCRN-CSC; ANN HENDRICKSON, MS, RN, ACNS-BC; MELANIE DUFFY, MSN, RN, CCRN, CCNS; AND MARYANN M. BROGDEN, ND, MSN, RN, APN-C, CCNS, CSRN HAVE YOU EVER WONDERED WHY? PRESENTATION ON EVIDENCE-BASED PRACTICE AND CORE ESSENTIALS PROGRAM, PRESENTED TO STAFF RNS AT LEWISTOWN HOSPITAL.NURSING RESEARCH/EBP CONFERENCE DECEMBER 13, 2018: DR RICHARD SCHREIBER, DIPLOMATE CLINICAL INFORMATICS, ASSOCIATE CHIEF INFORMATICS OFFICER VENOUS THROMBOLYTIC DISEASE: OLD DISEASE, NEW APPROACHES PAUL FRAUNDORFER, RPH, PHD PHARMACOLOGIC THERAPIES FOR VENOUS THROMBOEMBOLISM (VTE) DEBORAH AUDETTE, DNP, RN, ACNS-BC, CCRN-CSC A FOCUSED EDUCATION PROGRAM TO IMPROVE NURSES' KNOWLEDGE OF DELIRIUM, RECOGNITION AND IMPLEMENTATION OF PREVENTATIVE MEASURES MICHAEL HAFER, RN, EMT-B IMPLEMENTING A SITTER REDUCTION PROGRAM TO REDUCE COST WHILE MAINTAINING PATIENT SAFETY PEGGY TRAHAN, RN, PCCN, & JENNIFER KANE, BSN, RN, PCCN QUALITY IMPROVEMENT IN MEAL-INSULIN GAP POSTER PRESENTATIONS: DEBORAH AUDETTE, DNP, RN ACNS-BC, CCRN-CSC A FOCUSED EDUCATION PROGRAM TO IMPROVE NURSES' KNOWLEDGE OF DELIRIUM, RECOGNITION AND IMPLEMENTATION OF PREVENTATIVE MEASURES BETH BRADLEY, MSN, RN, & LEAH PARDOE, MAS, RNC-OB IMPROVING OBSTETRICAL PATIENT EXPERIENCE THROUGH INNOVATIVE MEDICATION COMMUNICATION KARRIE PETERSON, BSN, RN INTERDISCIPLINARY ROUNDING AND REDUCING THE PATIENT LENGTH OF STAY JUDY HIMES, BSN, RN, CWON, & LINDA O'BRIEN, BSN, RN, CWON IMPLEMENTING WOUND PHOTO DOCUMENTATION IN THE EMR: A PROCESS IMPROVEMENT INITIATIVE PATRICIA NOVAK, MSN, RN, & DONNA PUTNAM, MSN, RN REDUCING RESTRAINT USAGE THROUGH DE-ESCALATION TECHNIQUES LAUREN MCNAUGHTON, MSN, RN, CCRN, RACHAEL ENGLE, BSN, RN, CCRN, & AMY NEWELL, BSN, RN, CCRN RESTRAINT USAGE IN THE ICU ROBYN RHOADES, BSN, RN, MA, MA, NE-BC, ANDREA WEATHERFORD, BSN, RN, CEN, & LINDSEY LONGWELL, BSN, RN DECREASING DEPENDENCY ON AGENCY STAFF: HOW CAN OUR FLOAT POOL MEET OUR NEEDS? SHEILA MARIE RHODES, RN, CNOR, & TAMARA ANN RICE, RN, CPAN VTE INCIDENCE REDUCTION IN THE AMBULATORY SURGICAL CARE/DAY SURGERY SETTING THROUGH USE OF SCREENING AND PROPHYLAXIS PAMELA HARRIS-HAMAN, DNP, CRNP, NNP-BC, & MARTHA LEE, BSN, RNC, NIC EFFECTIVE SKIN CARE INTERVENTIONS ON PRE-TERM INFANTS IN THE NICU STUDENT POSTER PRESENTATIONS: JESSICA RYDER, BSN, RN, CCRN, & AMANDA SHEETS, BSN, RN, CCRN WITH MESSIAH COLLEGE SENIOR NURSING STUDENTS IN CORE ESSENTIALS PROGRAM THE USE OF FISH OIL TO PREVENT ATRIAL FIBRILLATION IN POSTOPERATIVE CARDIAC PATIENTS SARAH TROUTMAN, RN WITH MESSIAH COLLEGE SENIOR NURSING STUDENTS IN CORE ESSENTIALS PROGRAM EVIDENCE-BASED INTERVENTIONS TO INCREASE LABORING WOMEN'S SATISFACTION ANN MARIE MCKILLIP, RN WITH MESSIAH COLLEGE SENIOR NURSING STUDENTS IN CORE ESSENTIALS PROGRAM SAFE ADMINISTRATION OF PARENTERAL ANTIBIOTIC THERAPY (OPAT) THROUGH A PICC LINE IN PATIENTS WITH A HISTORY OF IV DRUG USE SHERRI HEFNER, RN-BC, & NICOLE SHEEDY, BSN, RN-BC WITH MESSIAH COLLEGE SENIOR NURSING STUDENTS IN CORE ESSENTIALS PROGRAM THE EFFECT OF CLEAR LIQUIDS TWO-HOURS PRE-PROCEDURE VERSUS CURRENT PRACTICE OF NOTHING BY MOUTH AFTER MIDNIGHT OTHER PRESENTATIONS: IMPLEMENTING A DELIRIUM PROTOCOL BUNDLE FOR OLDER ADULT POSTOPERATIVE HIP FRACTURE PATIENTS ON AN ORTHOPEDIC UNIT, ANN HENDRICKSON, DNP, RN, ACNS-BC, AT NURSING SHARED GOVERNANCE COUNCIL, 4/23/2019, GEISINGER HOLY SPIRIT GERIATRIC TRAUMA, ANN HENDRICKSON, DNP, RN, ACNS-BC, AT TRAUMA NURSE COURSE, GEISINGER HOLY SPIRIT, 5/9/2019 SEPSIS MAKING THE PIECES FIT - MARYANN M. BROGDEN-BRANDT, ND, MSN, RN, APN-C, CCNS, SCRN, CRITICAL CARE CLINICAL NURSE SPECIALIST/STROKE & SEPSIS COORDINATOR FEBRUARY 2019 STROKE HAPPENS KNOW THE FACTS PRESENTED BY MARYANN M. BROGDEN-BRANDT, ND, MSN, RN, APN-C, CCNS, SCRN, CRITICAL CARE CLINICAL NURSE SPECIALIST/STROKE & SEPSIS COORDINATOR AT ENCOMPASS HEALTH ON 5/23/19 AND MULTIPLE EMS GROUPS ON 11/26/28; 1/7/19; 1/10/19; 1/14/19OSA (OBSTRUCTIVE SLEEP APNEA) PRESENTED BY MARYANN M. BROGDEN-BRANDT, ND, MSN, RN, APN-C, CCNS, SCRN, CRITICAL CARE CLINICAL NURSE SPECIALIST/STROKE & SEPSIS COORDINATOR AT ENCOMPASS HEALTH STROKE SUPPORT GROUP 6/3/19.

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 expenses241,274,625

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,581,136	5,379,322	945,274

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	14,670

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

h Total. Add lines 1a-1f.......		14,670

		Business Code
2a	PATIENT SERV REVENUE	621110	301,523,668	301,523,668
b	INTERCOMPANY REV	621110	17,046,238	17,046,238
c	SALES REV GENERAL	621110	983,248	983,248
d	SELECT SPECIALTY HOSP	531120	687,540		687,540
e	EDUCATION	621110	32,356	32,356
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		320,273,050

3 Investment income (including dividends, interest, and othersimilar amounts) ......			51,841			51,841
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		290,424	6a
b	Less: rental expenses		0	6b
c	Rental income or (loss)		290,424	6c
d	Net rental income or (loss).......			290,424			290,424
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	850,219	55,629	7a
b	Less: cost or other basis and sales expenses	0	38,679	7b
c	Gain or (loss)	850,219	16,950	7c
d	Net gain or (loss).........			867,169			867,169
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	GAIN ON DEBT EXTINGUIS			2,604,489	2,604,489
b	OTHER REVENUE ANALYSIS			1,138,941		76,776	1,062,165
c	REBATE REVENUE			612,399			612,399
d	All other revenue ....			335,076			335,076
e	Total. Add lines 11a–11d ......			4,690,905
12	Total revenue. See instructions.....			326,188,059	322,189,999	764,316	3,219,074

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 ...........	1,236,478	11,638	1,224,840
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	730,849	401,300	329,549
7	Other salaries and wages........	92,683,883	88,134,887	4,548,996
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,372,916	4,462,084	-89,168
9	Other employee benefits .......	15,954,237	15,255,468	698,769
10	Payroll taxes ...........	7,131,787	6,821,639	310,148
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	42,709	14,593	28,116
c	Accounting ...........	46,456		46,456
d	Lobbying ...........	191,328	-11,666	202,994
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	30,426,569	28,387,716	2,038,853
12	Advertising and promotion ....	21,141	8,641	12,500
13	Office expenses .......	7,415,552	7,147,230	268,322
14	Information technology ......	1,762,807	1,431,252	331,555
15	Royalties ..
16	Occupancy ...........	7,638,018	3,480,265	4,157,753
17	Travel ............	385,788	296,625	89,163
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	20,215	5,864	14,351
20	Interest ...........	3,650,914	189,272	3,461,642
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	7,288,678	4,218,873	3,069,805
23	Insurance ...	3,899,101	17,569	3,881,532
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	INTERCOMPANY EXPENSE	54,004,397	24,030,705	29,973,692
b	MEDICAL SUPPLIES	47,861,900	47,743,617	118,283
c	UNCOLLECTIBLE EXPENSE	9,008,197	9,008,197	0
d	BOOKS,LIC,FEES,DUES	374,781	215,364	159,417
e	All other expenses	-87,925	3,492	-91,417
25	Total functional expenses. Add lines 1 through 24e	296,060,776	241,274,625	54,786,151	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 ........			1,117,607	1	343,100
2	Savings and temporary cash investments .........			5,034,174	2	24,235,536
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			38,186,837	4	35,356,135
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 .......
				39,640	5	19,743
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 ...........			1,234,437	7	2,648,664
8	Inventories for sale or use ............			5,132,243	8	5,554,233
9	Prepaid expenses and deferred charges ......			2,513,876	9	2,731,775
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	45,689,342
b	Less: accumulated depreciation	10b	25,152,973	18,229,353	10c	20,536,369
11	Investments—publicly traded securities .			4,696,299	11	3,998,407
12	Investments—other securities. See Part IV, line 11 .....			32,587,874	12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			3,247,927	15
16	Total assets. Add lines 1 through 15 (must equal line 33)...			112,020,267	16	95,423,962

17	Accounts payable and accrued expenses .....	3,839,652	17	3,838,457
18	Grants payable ...		18
19	Deferred revenue .........		19	25,790,683
20	Tax-exempt bond liabilities .........	116,393,956	20	4,194,445
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 .........
		681,047	22	603,410
23	Secured mortgages and notes payable to unrelated third parties ..		23	11,549,513
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	40,403,988	25	62,779,985
26	Total liabilities. Add lines 17 through 25..	161,318,643	26	108,756,493

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-56,772,050	27	-15,970,066
28	Net assets with donor restrictions ...........	7,473,674	28	2,637,535
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-49,298,376	32	-13,332,531
33	Total liabilities and net assets/fund balances ........	112,020,267	33	95,423,962