2013 CPP Annual Report

stability | control | expertise 2013 ANNUAL REPORT

INDEX 03 PRESIDENT’S MESSAGE 04 YEAR IN REVIEW 06 EDUCATION 07 GROWTH 09 OUR SERVICES 13 TREASURER’S REPORT 14 OPERATING RESULTS AND FINANCIAL POSITION 18 LEADERSHIP

PRESIDENT’S MESSAGE On behalf of the Board of Directors of the Central Pennsylvania Physicians Risk Retention CHARLES “CHIP” MERSHON, MDGroup (CPP), it is my pleasure to provide you with this 2013-2014 annual report of CPP, which Cornerstone Family Health Associateshighlights your company’s accomplishments in 2013 and through the first half of 2014. A Practice of Physicians Alliance, Ltd. In 2013-2014, the healthcare industry experienced an acceleration of post-ACA initiatives,including patient experience of care, value over volume, and new reimbursement and caremodels. Because of CPP’s proactive approach to understanding your health care and liabilityenvironment, your company is well-poised to support you. A few accomplishments in thisregard include: • Launch of a specialty-specific patient experience survey pilot program. • A focus on understanding the post-ACA changes impacting physician practice and reimbursement. • Continued work with SE Healthcare Quality Consulting, LLC (“SE”) and its leading, national clinical, reimbursement, health policy, and safety experts in providing members with best in class clinical risk support. • Introduction of financial wealth management resources in The Abernathy Group II Family Office and Abundance Wealth Counselors. • Evaluated and obtained cyber liability coverage for insured policies beginning 7/1/14. CPP continues to perform well financially.  As of June 30, 2014, the Company had$22,382,739 of surplus and total assets of $62,851,519.  The company plans to continually buildsurplus in order to provide security and innovation to our members. I also want to take this opportunity to welcome two board member additions: SuzetteSong, MD, and Chris Stormer, CPA, while also thanking departing board member Joseph Levan,MD, who ended a 10-year tenure. Of course, it was also a year in which we lost past boardchairman John Gastaldo, MD, who we will always miss. Importantly, thank you to CPP members, our colleagues. You are the reason that thiscompany exists, and it is always its mission to provide you with valued services in an ever-changing environment.

YEAR IN REVIEWRISK MANAGEMENT In 2013-2014, our safety and risk management program was nimble enough to address not only new and changing liability risk exposures forphysicians, but also changes in the post-ACA environment focused on value. We moved forward with not only assuring that insureds had supporton the “basics” such as procedure-specific informed consents and other tools; focused educational programs; and event management, but alsotaking CPP’s support of physicians to the next level: Analyzing, creating, and providing strategies and support to help them be successful in thisenvironment. Our team of clinical, risk, reimbursement, and legal experts, including L. Gregory Pawlson, MD, MPH; and Paul Gluck, MD, worked with leadingpatient safety experts and methodologists, including Diane Pinakiewicz, MBA, MPH, immediate past president of The National Patient Safety Foun-dation, to identify and analyze key post-ACA needs of Pennsylvania physicians. Key areas identified included: 1) Patient experience of care; 2) Patient engagement; 3) Specialty-specific metrics; and 4) Efficiencies in careprocesses and collaboration. From the multi-disciplinary teamwork, we created and introduced two valuable analytical tools: PATIENT EXPERIENCE SURVEY PLATFORM CLINICAL SAFETY AND RISK MANAGEMENT DASHBOARD Negotiated discount pricing for CPP insured Collected and analyzed OB safety and liability risk and use of a pre-approved patient experience survey. provided support to OB practices in impementation of evidence-based safety and risk mitigation strategies. Launched a patient experience pilot program for free support to insureds using the Created additional specialty-specific clinical and specialty-specific patience experience survey platform. safety dashboards for gastroenterology, orthopedics,4 | 2013 CPP Annual Report family practice and general surgery.

SE Healthcare Quality ConsultingInsureds continued to receive valuable clinical safety and risk support through SE’s innovativerelationship with SE Healthcare Quality Consulting (SE). SE’s resources include experts in gas-troenterology, general surgery, minimally invasive surgery, orthopedics, obstetrics, gynecology,cardiology, and emergency medicine. For example, Peter Cotton, MD, a pioneer in digestiveendoscopy, and professor of medicine at the Digestive Disease Center at the Medical Univer-sity of South Carolina, who assisted in the creation of our gastroenterology clinical and safetydashboard, identified key GI metrics, and development of GI patient experience of care criteria.Event Management and Defense of ClaimsCPP’s event management program provides insureds with 24/7 support, attacking the “plus fac-tors” that impact patient satisfaction and ultimately professional liability risk. Defense of claimscontinues to include a multi-disciplinary team that includes nationally-regarded doctors andnurses with experienced defense lawyers and a commitment to partner with our insureds.On the HorizonIn 2014-2015, we will leverage our “value” foundation to innovatively help CPP insureds not onlymitigate risk, but also address post-ACA quality of care, efficiency, and reimbursement expecta-tions and changes. Highlights include: • Live/streaming educational presentation for insureds, “Being Successful – New Environ- ment: Patient Engagement...The Silver Bullet”, presented by James W. Saxton, Esq. • Introduction of 30 on-line, just in time learning modules focused on practice systems, prac- tice culture, patient safety and risk mitigation, and patient experience of care. • Creation of our new specialty-specific clinical effectiveness dashboard. 2013 CPP Annual Report | 5

EDUCATIONIn 2013-2014, your CPP team created on-line, adult-based NEW TOOLS, TEMPLATES ANDeducation modules set to go live in 2014-2015, and are acces- MORE IN 2013-2014sible at no charge to all CPP insureds. Sterilization Procedures – AutoclavesOTHER EDUCATIONAL SEMINARS Model Infection Exposure Control Plan“Patient Safety in the Office Setting: An introduction to Core Patient Safety Principles”Audience: Insureds, practice managers, and staff Sepsis Identification / Intervention CarePresenter: Paul Gluck, MD Bundles“Changes to the Privacy and Security Provision of HIPAA” Collaborative Agreement SamplesAudience: Practice managers and staffPresenter: Stephanie Sher, Esq. Collaborative Agreement Checklist“Engaging Your Staff as Part of Your Team: Effective Strategies” Procedure-specific Informed ConsentAudience: Practice managers Forms - 100’s addedPresenter: C. Lynn Swisher, Ph.D. Guidelines for Leaving Telephone“Patient Engagement as a Driver of Patient Safety” Messages for PatientsAudience: Practice managers and staffPresenter: Diane Pinakiewicz, MBA, CPPS Authorization to Leave PHI by Alternative Means“Electronic Health Records (EHR): Understanding the Risks”Audience: Practice managers Student Confidentiality AgreementPresenter: Matt Rappleye, Esq. Recall Tracking Log“ERISA Compliance: The Ticking Time Bomb”Audience: Practice managers Visiting Physician: Observation FormPresenter: The Abernathy Group II Physician Observer Confidentiality“Patient Experience Surveying” AgreementAudience: Practice manages, staff, and insuredsPresenters: Judi Olnick, CPHQ, and Doug Shand Informed Refusal for Post-Allergy Injection Office Wait Policy - Amendments and Addendums to Medical Records and Voice Recognition Generated Documents6 | 2013 CPP Annual Report

MEMBERSHIP GROWTH14001300120011001000 900800 947 947700 867 863 838 880 904 959600 796500 688400 520300 217 245 247 253 270200 221171 217 217 217 217100 129 213 66 86 134 122 128 135 141 146 134 0 60 86 122 2008 129 129 129 23 113 23 2004 2005 2007 2009 2010 2011 2012 2013 2006 2003 Corporations Year Ending Physicians Allied HealthOur strong market presence has transformed the medical professional liability market in Pennsylvania. Since our formation in 2003, CPP has seenover 99% of the physicians with the opportunity to renew, continue with the program. We are a leader in our market and continue to attractestablished physician practices to our program. We possess the financial strength to pursue our strategy of controlled, steady growth. 2013 CPP Annual Report | 7

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OUR SERVICESCentral Pennsylvania Physicians Risk Retention Group, Inc., is a medical professional liability insurance company. We insure physicians. We insureour members’ affiliated professional corporation or entity and allied health professionals employed by member physicians or corporations. We arein the business of managing risk.OUR STRATEGYAs a mutual company, we are not obligated to any outside investors or stockholders. Our business practices reflect the best interests of our members.Our overriding goal is to provide a superior risk management and insurance product that enhances patient safety, patient satisfaction and serviceexcellence.OUR OPERATING PRINCIPLESw As a physician-focused company, 5 of 8 board members are insured by Central Pennsylvania Physicians. The decisions affecting your future are made by people with incentives and values that are in direct alignment with yours.w We invest in strategies that provide a long-term reduction in the exposures that cause claims.w Members are provided confidential access to lawyers and risk management consultants to manage events when they do occur.w We invest in educational programs and resources that improve business and customer service practices, and educate our members to implement proven risk reduction strategies.w We are committed to disciplined underwriting through careful risk selection and conservative pricing.w We will maintain adequate capital and sufficient liquidity to protect our members.w Our primary investment objective is the preservation of capital by minimizing the probability of loss over the investment horizon. Our emphasis is placed on minimizing return volatility rather than maximizing total return.WE BELIEVECentral Pennsylvania Physicians Risk Retention Group is well equipped for continued success and growth. We have worked hard tobuild a solid foundation for our operations. We are equipped to withstand today’s volatile economic pressures and market influences.Our strong operations performance, capital strength, skillful and prudent investing practices, and experienced team of professionalscombine to create an enterprise equipped to deliver value and service to our members. 2013 CPP Annual Report | 9

FINANCIALS The financial information provided in this report has been derived from our financial statements audited by Johnson Lambert & Co., LLP. Our members may obtain a complete set of audited financial statements and notes upon request.$65,000,000 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013$60,000,000$55,000,000$50,000,000$45,000,000$40,000,000$35,000,000$30,000,000$25,000,000$20,000,000$15,000,000$10,000,000 $5,000,000 $0 2003 Assets Capital & Surplus Written PremiumTOTAL TOTAL POLICYHOLDER GROSS WRITTEN NETASSETS SURPLUS PREMIUM INCOME$59,433,487 $21,405,511 $14,182,845 $ 596,28710 | 2013 CPP Annual Report

AT DECEMBER 31 2013 2012 2011 BALANCE SHEET 53,224,605 4,586,949ASSETS 52,533,118 53,978,208 Investments 4,066,012 4,755,179 469,090Cash and cash equivalents 58,638Accrued investment income 430,736 434,953 Premiums receivable 215,554 74,920 -Receivables - capital contribution 1,412,791MCARE due from policyholders - - Deferred policy acquisition costs 1,052,509 893,307 177,119Prepaid expenses 159,810 369,143Deferred federal income tax 176,952 356,197 67,479 Total Assets 390,475 60,628,702LIABILITIES AND POLICYHOLDER SURPLUS - Loss and loss adjustment expenses - 60,765,713 31,619,135Unearned premiums 59,433,487 4,823,721Premiums received in advance 31,269,860 2,743,602Policyholders’ dividends payable 29,297,688 4,467,518 Payable to MCARE 4,739,049 2,716,810 -Losses payable 2,125,013 1,657,515Accounts payable and accrued expenses - Federal income taxes payable - 969,781 - Total Liabilities 1,130,822 416,583Policyholders’ Surplus - Contributed capital - 464,662 -Other comprehensive income 523,163 41,307,279Retained earnings (loss) - Total Policyholders’ Surplus - 40,224,906 8,457,699 38,027,977 2,388,670 8,013,144 8,475,054 7,864,412 2,958,605 19,321,423 3,375,753 9,569,058 60,628,702 10,165,345 20,540,807 21,405,510 19,476,564 1,387,770 Total Liabilities and Policyholders’ Surplus 59,433,487 60,765,713 678,190 STATEMENT OF OPERATIONS AND COMPREHENSIVE INCOME (LOSS) 21,542,524REVENUES 13,911,314 13,631,990 16,142,909Premiums earned 1,293,860 1,443,814 662,858Net interest and dividend income 1,311,455 Net realized gains (loss) from investment 16,516,629 742,955 2,144,772 Total Revenues 15,818,759 950,683EXPENSES 12,283,937 11,126,661 19,901,222Loss and loss adjustment expenses 692,325 681,098 Policy acquisition and underwriting expense 1,641,302Professional and management fees 2,010,970 1,960,054 (6,824)General and administrative expenses 1,217,897 962,899 Total Expenses 16,205,129 1,648,126 Income Before Policyholder Dividends 14,730,712 125,943 Federal Income Tax 311,500 Policyholders’ Dividends - 1,088,047 1,522,183 Income Before Federal Income Tax - Federal Income Tax Expense 311,500 1,522,183 (284,787) 1,088,047 1,670,573 (5,957) 2,745,151 Net Income (Loss) 596,287 1,094,004 2013 CPP Annual Report | 11NET INCOME AND OTHER COMPREHENSIVE INCOME (LOSS)Net income (loss) 596,287 1,094,004 Other comprehensive income 417,148 569,935 Comprehensive Income 1,013,435 1,663,939

FINANCIALS 7% 21% 24%33% 1% 60% 78% 76% Investment Portfolio Equities  78.0% Fixed Maturities 76%Fixed Maturity Securities 60.0% Common Stock 1.0% Municipal Securities 24%Equities 33.0% Preferred Stock 21.0% Corporate Debt Securities Cash and Cash Equivalents 7.0% Limited Partnership BREAKOUT OF CASH AND INVESTMENTS Fixed Maturities 33,830,288 US Treasury Securities and Obligations of 0 US Government Corporations and Agencies 25,569,929 Municipal Securities 8,260,359 Corporate Debt Securities Equities 18,652,830 Common Stock 14,560,238 Preferred Stock 247,910 Limited Partnership 3,844,682 Cash and Cash Equivalents 4,066,012 TOTAL CASH AND INVESTMENTS 56,549,13012 | 2013 CPP Annual Report

TREASURER’S MESSAGE Central Pennsylvania Physicians (“The Company”) maintained its footing in a very com- WAYNE R. CONRAD, MDpetitive market during 2013. By 2013 year end, total assets were $59.4 million; a decrease of Lancaster Orthopedic Group$1.4 million from the $60.8 million in assets at the end of 2012. However, the Company’s value Orthopedic Surgeryincreased in 2013 with capital and surplus of $21.4 million up from $20.5 million in 2012.The medical professional liability insurance marketplace continues to be very competitive asa result of hospital acquisitions, mergers, and competition amongst traditional and captivecarriers. In 2013, the Company wrote approximately $14.2 million in gross premiums, comparedto $13.3 million in 2012. Premiums are earned evenly over each policy period. The Companyhad net premiums earned of $13.9 million in 2013, up from $13.6 million in 2012. The Com-pany had net income before policyholder dividends and federal income taxes of $311,500.After accounting for dividends and income taxes the Company’s net income was $596,287,compared to $1.09 million in 2012. The Company’s investment portfolio performed well in 2013 despite the continued chal-lenges of the low interest rate environment. The investment committee works closely withour professional advisors to ensure the portfolio is managed within clearly defined risk andasset allocation guidelines. Our investments generated a net gain of $2.6 million, comparedto a net gain of $2.2 million in 2012. This net gain was achieved through interest and dividendincome of $1.3 million and net realized gains of $1.3 million as well. At the end of 2013, theCompany’s investment portfolio was valued at approximately $56.6 million and the invest-ment returns continue to be a significant contributor to the profitability of the Company. 2013 CPP Annual Report | 13

OFIPNEARNACTIIANLGPROESSIUTLIOTNS ANDIn this section we review our 2013 operating results and our financial position at year-end 2013. In assessingour results we apply several widely-recognized insurance industry ratios used to monitor the profitability andfinancial strength of property and casualty insurers. In addition to utilizing financial reports and industry ratios,the Board of Directors relies heavily on our actuaries, accountants, professional advisors and regulators to assistin monitoring our performance. OPERATING RESULTS These expenses totaled $3.92 million in 2013 and $3.60 million in 2012. Many of these fees are based on a percentage of gross written Premiums premiums. In 2013, we wrote approximately $14.18 million in gross premiums, compared to $13.28 million in 2012. Net Income The Company had net income before policyholder dividends and Premiums are earned evenly over the policy Period. The Company federal income taxes of approximately $311,500. We had a net federal had net premiums earned for the year of $13.90 million in 2013 and tax benefit of $284,787, resulting in net after tax income $596,287. $13.63 million in 2012. After accounting for “Other Comprehensive (Loss) Income,” which consists of adjustments for changes in the market value of the Investment Income Company’s investments, net of tax benefit or expense, less adjustment We had net interest and dividend income of $1.29 million in 2013, for reclassification of realized losses or gains in the Company’s compared to $1.44 million in 2012. In 2013, we experienced net investments, the Company’s Comprehensive Income in 2013 was realized gains from investments of $1,311,455 compared to a net $1.01 million, compared to $1.66 million in 2012. realized gain of $742,955 in 2012. FINANCIAL POSITION AT YEAR END 2013 Taking into consideration both net investment income and realized investment gains, our investments generated a net gain in 2013 of Assets $2.60 million, compared to a net gain of $2.18 million in 2012. Total assets for the Company at December 31, 2013 were $59.43 million, compared to $60.77 million at year-end 2012. Approximately Expenses $56.60 million of our assets are held in investment accounts ($52.63 The Company has two main categories of expenses. Our largest million) and cash or cash equivalents ($3.97 million). category of expenses is loss and loss adjusting expense. In 2013, we had loss and loss adjustment expense of $12.28 million, compared to Liabilities $11.13 million in 2012. This expense is comprised of estimates of the At year-end 2013, our total liabilities were $38.03 million, compared cost of resolving open claims, plus an actuarial estimate for additional to $40.22 million on December 31, 2012. Our principal liabilities are adverse development on such claims and estimates of claims incurred reserves for loss and loss adjustment expenses of $29.30 million and but not yet reported (“IBNR”). unearned premiums of $4.74 million. The Company’s other principal expenses are underwriting expenses which consist of management fees, loss control and event management fees, broker fees, and other miscellaneous expenses.14 | 2013 CPP Annual Report

Policyholders’ SurplusIn general, policyholders’ surplus represents the excess of theCompany’s assets over its total liabilities. In effect, it represents theCompany’s cushion for absorbing adverse operating results. AtDecember 31, 2013, our total policyholders’ surplus was $21.40million, an increase of $864,704 over 2012. At year end, 37% of ourpolicyholders’ surplus was attributable to the capital contributed byour policyholders and 63% resulted from retained earnings of theCompany.FINANCIAL RATIOSThere are a number of ratios commonly used to assess the financialperformance of property and casualty insurers. In general, ratios can beused to measure the profitability, liquidity, and balance sheet strengthof a company. Certain profitability ratios have been developed tomeasure the income and expenses of an insurer in relationship to itsearned premiums in a given year. Our profitability ratios for 2013 aresummarized below:Loss Ratio = incurred loss and loss adjustment expense/earnedpremiums = 88.0%.Current results are higher than the 81.6% ratio in 2012.Expense Ratio = underwriting expense/earned premiums =27.6%Our Expense Ratio compares favorably to our expectations and isconsistent with industry standards for companies of similar size.Combined Ratio = Loss Ratio + Expense Ratio = 115.6%The Combined Ratio is a measure of the overall results of theCompany’s underwriting operations. A Combined Ratio of less than100% indicates the insurer’s underwriting operations are profitable,without reliance on investment income.Investment Income Ratio = net investment income/earnedpremiums = 19.0%This indicates positive overall investment results in 2013.Operating Ratio = Combined Ratio - Investment Income Ratio= 96.6%.The Operating Ratio is intended to measure an insurer’s overallpretax operational profitability from both its underwriting andinvestment activities. Because our investment operations produce apositive result, the Operating Ratio is lower than the Combined Ratio,indicating greater overall profitability. 2013 CPP Annual Report | 15

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The business of insurance is strictly regulated. It is in the best interest of our members that webe subjected to independent and comprehensive review. The following summarizes the natureand scope of the applicable regulation and audit:SOUTH CAROLINA DEPARTMENT OF INSURANCE Approval of Rates and FormsWe are a licensed, mutual insurance company qualified as a risk As a risk retention group, we are not required to obtain regulatoryretention group under the federal Liability Risk Retention Act of 1986. approval of our rates and forms. However, the South CarolinaAs such, we are subject to primary regulatory supervision by the Department of Insurance requires that we submit a report from theDepartment of Insurance in South Carolina, our state of incorporation. independent actuary regarding the adequacy of our rates.In addition to ongoing oversight by the Department, we are required tosubmit to examinations by South Carolina’s Department of Insurance. OTHER REGULATORY SUPERVISION PENNSYLVANIA DEPARTMENT OF INSURANCEFederal Preemption of State Regulation The federal Liability Risk Retention Act requires that we register in eachInsurance has traditionally been an area regulated by the states, and that state in which we operate. The Commonwealth of Pennsylvania hasregulation can be burdensome. However, in enacting the Liability Risk approved our operation as a risk retention group in Pennsylvania.Retention Act, Congress preempted most state regulation of risk retentiongroups. The state of a risk retention group’s incorporation retains the Insurance Guaranty Associationsprimary regulatory supervision over the group, but under a regulatoryprocess that does not encompass certain cumbersome regulations and Most states require insurers to become members of insolvencyrequirements. This preemption of state regulation provided a particularly funds or associations. Members of these funds must contributeeffective way for the group to form and begin to insure its members, and to the payment of certain claims made against insolventcontinues to benefit the group. insurers. Under the Liability Risk Retention Act, risk retention groups are specifically exempted from participation in stateFinancial Statements guaranty funds. This means we are not subject to participation in the Pennsylvania Property and Casualty Insurance GuarantyWe are required to file annual and quarterly financial statements with Association, the association that covers malpractice insurerthe South Carolina and Pennsylvania Departments of Insurance. These insolvencies in Pennsylvania. Therefore, we neither pay into, norstatements must be prepared on the standard forms promulgated by receive any benefits from, the guaranty association.the National Association of Insurance Commissioners. We must alsoprovide an annual statement of opinion on loss and loss adjustment Medical Malpractice Reportsexpense reserves made by an actuary or a qualified loss reserve specialist.Additionally, we are required to provide a yearly, independent third party As a medical professional liability insurer, we must report to stateaudit of our financial statements. regulatory agencies and the National Practitioner Data Bank detailed information regarding settlements and judgments against our insureds.Policyholder Dividends This information could include payments; claims closed without payments; and actions by the group such as terminations or surchargesThe prior approval of the South Carolina Department of Insurance is with respect to our members. We may be subject to penalties if werequired before any policyholder dividend may be paid. fail to report to either the appropriate state agency or the National Practitioner Data Bank.InvestmentsStable investment returns are an important component of the operatingresults of any insurance company. We manage our investment portfolioin accordance with South Carolina law which sets various parameters toprevent the purchase of unsuitable assets and to ensure the portfoliodoes not become overly exposed to individual securities, issuers or riskyasset classes. 2013 CPP Annual Report | 17

BOARD OF DIRECTORSCHARLES R. MERSHON, MD C. RON DUNCAN, MDCornerstone Family Health Associates Annapolis Radiology AssociatesA Practice of Physicians Alliance, Ltd. RadiologyFamily Medicine Vice PresidentPresident and Chairman of the Board Quality Assurance CommitteeExecutive Committee Executive CommitteeInvestment Committee Claims CommitteeUnderwriting Committee Underwriting CommitteeClaims Committee GARY D. OTT, MDWAYNE R. CONRAD, MD Total Woman Health and Wellness OB/GYNLancaster Orthopedic Group OB/GYNOrthopedic Surgery Underwriting CommitteeSecretary/TreasurerExecutive CommitteeInvestment CommitteeClaims CommitteeTHOMAS HELINEK, MD, PhD SUZETTE J. SONG, MDWest Reading Radiology Associates OSS HealthRadiology Orthopedic Surgery New board member 2014SCOTT R. MANN, MD CHRISTOPHER STORMER, CPAWhite Rose Family Practice Bauknight Pietras & Stormer, P.A.Family Medicine Investment CommitteeUnderwriting Committee New board member 2014ADDITIONAL QUALITY ASSURANCE COMMITTEE MEMBERSKIMBERLY M. BROWN, PA-C JAMES W. SROUR, MD BRYAN L. YINGLING, MDOyster Point Family Health Center, Gastroenterology Associates of York, PC Susquehanna Valley Women’s Health Care Gastroenterology Obstetrics and Gynecology a Practice of Physicians Alliance, Ltd.Physicians Assistant18 | 2013 CPP Annual Report

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STRATEGIC PARTNERSEvent Management & Defense CORPORATE OFFICERisk Management & LegalStevens & Lee 177 Meeting Street, Suite 470stevenslee.com Charleston, SC 29401Claims Administration / Marketing SALES & SERVICEand Policyholder Services / UnderwritingMurray Securus 39 North Duke Streetmurrayins.com P.O. Box 1728 Lancaster, PA 17608-1728Captive ManagementAdvantage Insurance Management CPPRRG.COMaihusa.comActuarialDeloitte Actuarial Servicesdeloitte.comAuditingJohnson Lambert & Co.jlco.comInvestmentsMerrill Lynchml.comClinical Best Practices and MetricsSE Healthcare Quality Consultingsequalityhealthcareconsulting.comPersonal Wealth ManagementThe Abernathy Group IIabbygroup.comRetirement Plan SolutionsAbundance Wealth Counselorsabundancellc.comPatient Experience SurveyingMedStatixmedstatix.com