Geisinger Endowment Report 2022

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Geisinger Endowment Report

Fiscal Year 2022 (January 1–December 31, 2022)

Investment management at Geisinger

The Geisinger Health Board of Directors has established a Finance Committee and an Investment Subcommittee to assist with oversight and monitoring of Geisinger’s investments. The Investment Subcommittee monitors performance relative to Geisinger’s investment objectives, and meets regularly to discuss capital markets, investment strategy, risk parameters, investment policies and asset allocations. Endowment assets are invested alongside other long-term operating assets of Geisinger. Geisinger engages third-party investment managers and an independent investment consultant to assist with oversight of investment assets. These parties coordinate closely with Geisinger leadership on the day-to-day management and operations of Geisinger’s investments.

Endowment investment objectives

• Preserve the real spending power of the assets

• Grow assets over the long term more than inflation

• Optimize the long-term investment return for an appropriate level of risk

Endowment investment strategy and asset allocation is developed in adherence with these principles:

• The focus on a long-term investment horizon (perpetuity) can provide opportunities to avoid distractions from, and take advantage of, short-term volatility.

• Investment markets are largely efficient, yet not perfectly efficient, which allows for targeted opportunities to exploit these inefficiencies.

• Investment markets are increasingly global, and it is important to understand the differing risk and return profiles across all assets, globally.

• We seek to exploit opportunities to enhance total portfolio returns through broad diversification across asset classes with low correlations.

Endowment structure

As of December 31, 2022, approximately 201 individual restricted endowment funds, comprising $83 million, were held as investments for Geisinger. Endowments have been created to support a broad range of programs, departments, and initiatives across Geisinger. Critical to our future, endowments afford us the financial stability to make strategic investments in the health and well-being of our communities. As our research programs continue to expand and grow, these gifts will allow leadership to plan and allocate resources knowing that funding sources are secured.

The chart to the right shows a break-down of endowment funds categorized by purpose.

GEISINGER HEALTH FOUNDATION
Education 11% Clinical 52% Community 3% Research and Innovation 34%

Endowment growth

An important component of maintaining the value of endowments into perpetuity is to set a sustainable endowment spending rate that balances near-term objectives with the need to maintain the real value into perpetuity. Spend too much and the real purchasing power will erode through time, while spending too little will fail to adequately support the near-term needs of the designated purpose of the endowment. To aid in the analysis of the spending rate, leadership gathers and analyzes forward capital market assumptions from our consultant and other sources that are based on both near-term and longer-term projections.

For the current year, the Investment Subcommittee approved leadership’s recommendation of a 4.25 percent spending rate calculated from the average fair market values for the preceeding three years. We use a three-year rolling average market value to help smooth the impact from short-term market volatility. Recent peer studies show that Geisinger’s effective spending rates are broadly in line with the average endowment spending rates over the prior ten-year period.

Waterfall of total endowment flows

Over the past year, Geisinger received approximately $1.2 million in gifts and transfer into endowment assets while providing $3.8 million in spending support to Geisinger entities. The endowment experienced $15.14 million of realized and unrealized losses.

2022 Endowment Flow

$120 $100 $80 $60 $40 $20 0 $100.7 $1.2 -$3.8 -$15.1 $83.0 Starting Balance Contributions Spending Net Investments Ending Balance Increase Total Decrease
M i l l i o n s

Portfolio positioning and performance

Historical data verifies that asset allocation is the biggest determinant of risk and return. Geisinger’s endowment asset allocation is reviewed and approved by the Finance Committee upon input from the Investment Subcommittee, consultant, and Geisinger leadership. The asset allocation seeks to diversify the portfolio across asset classes to maximize returns within the risk constraints of the funds.

Long-term fund asset allocation (as of December 31, 2022)

Long-term fund asset sub-allocation (as of December 31, 2022)

Strategic Target Total Equity Total Fixed Income 30% 70% Actual Total Equity Total Fixed Income 37% 63% 35 30 25 20 15 10 5 0 Strategic Target Actual 29 30 38 33 19 2 2 7 3 3 0 4 1 0 3 5 2 1 1 0 VentureCapital InternationalEquity USEquity EmergingEquity Cash FixedIncome — IG FixedIncome — HY Buyout Infrastructure NaturalResources 40 19 7 12 18 21 10

Long-term fund performance

Endowment returns for the prior one-, three-, five-, and ten-year periods are included in the chart below. Over longer-term time periods including the prior five and ten years, Geisinger’s long-term fund has generated returns that exceed the median of other healthcare operating funds.

[1] Healthcare peer return data provided by Geisinger’s investment consultant Mercer Investments, LLC. Data set reflects the net of fees performance for the Investment Metrics All Healthcare peer group.

Geisinger has maintained historical fund and performance data of the long-term fund since October 1, 2003. Over this 19.25-year period, the endowment has exceeded the policy objective of CPI +4 percent that was in place for most of this period. The hypothetical growth of $1 million is shown in the chart below.

Long-term fund: hypothetical growth of $1 million

Geisinger Health Foundation 40-36

100 N. Academy Ave.

Danville, PA 17822

570-271-6461

stewardship@geisinger.edu

Geisinger long-term fund Median return of other healthcare operating funds [1] -14.5% 3.8% 4.5% 5.7% -12.1.% 2.3% 3.5% 5.3% 1-Year 3-Year 5-Year 10-year Sept.2003 Sept.2004 Sept.2005 Sept.2006 Sept.2007 Sept.2008 Sept.2009 Sept.2010 Sept.2011 Sept.2012 Sept.2013 Sept.2014 Sept.2015 Sept.2016 Sept.2017 Sept.2018Sept.2019 Sept.2020 Sept.2021 $4.0 $3.5 $3.0 $2.5 $2.0 $1.5 $1.0 $0.5 M i l l i o n s Geisinger Long-Term Fund CPI+4% Sept.2022

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