Fighting the COVID-19 Pandemic, Keeping North Carolinians Healthy 2020 Annual Report 4 Table of Contents 2 Leading in the Moment … Envisioning a Better Future 4 UNC Health System Update 2020 8 Our Values 9 School of Medicine Continues Medical Education Excellence Despite the Pandemic 11 U.S. News Rankings 13 This Year in Research 21 UNC Health Alliance 22 UNC Senior Alliance 23 Community Relations 26 Volunteer Highlights Financials & Statistics 28 Letter of Transmittal 13 31 UNC Health Reporting Structure 32 UNC Health Board of Directors 33 Management’s Discussion and Analysis 38 Pro Forma Statement of Net Position 39 Statement of Revenues, Expenses, and Changes in Net Position 40 Pro Forma Statement of Cash Flows 41 UNC Faculty Physicians Statement of Net Position 42 UNC Faculty Physicians Statement of Revenues, Expenses, and Changes in Net Position 43 UNC Faculty Physicians Statement of Cash Flows 44 Pro Forma Selected Statistics 45 Notes to the Pro Forma Financial Statements Cover: Photo courtesy of Scott Sharpe, News & Observer Pictured: Registered nurse Emily Howarth in the Medical Intensive Care Unit at UNC Medical Center 23 2020 Annual Report 1 Leading in the Moment … Envisioning a Better Future As UNC Health issued its annual report for Fiscal Year 2019 (printed in March 2020), the world was beginning to focus on a new or “novel” virus, the SARS-CoV-2. North Carolina confirmed its first case of COVID-19 on March 3, 2020. Shortly thereafter, our state went into a “shelter in place” lockdown that began months of personal isolation, wearing masks, social distancing, working from home, online classes, etc. Graduation ceremonies moved from auditoriums and football stadiums to our computer screens. We did all of this and much more in an attempt to “flatten the curve” and slow the spread of the disease. Even still, as of March 2021, COVID-19 has taken more than 500,000 American lives. Between the many professional and personal challenges of the last year, for all of us, including the pandemic, social and political unrest and violence through the election and in the first weeks of 2021, kids at home in school, a winter holiday where many of our co-workers were caring for patients and others of us unable to gather with our families, and many more unique issues for each of us, it won’t surprise you to read that this has been and continues to be a very tough time. 2 The University of North Carolina Health System Unexpected, but prepared. In many ways, everything all of us have done in our training and throughout our careers in medicine has prepared us for this time and the work we are doing, but until you are in the midst of a crisis, there is no way to predict how you will respond. We can say unequivocally that our One Great Team was up to the challenge. There has been a sense of urgency and intensity for all of us. At times, there were decisions that were unclear or had to be corrected. There have certainly been missteps along the way. We believe, though, there were many, many more steps in a positive direction. We have never seen so many people work so hard for such a lengthy time in our lives. While our colleagues in the health system worked to care for patients, our colleagues in the School of Medicine were at the forefront of key research around virus identification, the development of faster and more accurate testing, development and testing of treatments such as remdesivir and monoclonal antibodies and leading clinical trial sites for the vaccines. The pace with which we set up vaccination clinics across the state, and in fact, led in vaccinating both our workforce and the public, was nothing short of amazing. UNC Health / School of Medicine Bring Hope It is important for us to acknowledge the difficulties of the moment, but what defines us is the ability to see a way through a difficult situation, envisioning a future when we are beyond the current problem and motivating others to work together toward that future. In the depths of World War II, when it looked as though Great Britain might be conquered, Prime Minister Winston Churchill delivered an address that is applicable to our situation today. Churchill said of his beloved country, “If the British Empire and its Commonwealth last for a thousand years, men will still say, ‘This was their finest hour.’” This year has been difficult, both personally and professionally for us. But, we were motivated by our mission and the knowledge that the people and the state we serve were counting on us. Although we continue to face difficulties now, it will not last rever,fo and when we finally find ourselves on the other side of this crisis, we are certain that the strong bonds forged over the last year will help us work better together and better serve our state for years to come. We are proud to be North Carolina’s health system. Sincerely, Wesley Burks, M.D. Charles D. Owen, III CEO, UNC Health Chair, UNC Health Board of Directors Dean, UNC School of Medicine 2020 Annual Report 3 UNC Health System Update 2020 While 2020 has posed unprecedented challenges, UNC Health has remained focused on our mission: improving the health and well-being of the people of North Carolina. This year, thanks to the dedication of all 35,000 members of our One Great Team, UNC Health excelled across all aspects of that mission. 4 The University of North Carolina Health System We all owe incredible thanks and gratitude to the thousands bring testing services to those who needed them the most, of compassionate coworkers and providers who have cared communities hardest hit by the virus, and lacking access to for patients this year, under stressful and ever-changing high-quality care. UNC Health’s Mobile COVID-19 Testing circumstances. Their dedication has truly been heroic. effort has been an important partnership with many groups across our community: local governments, faith leaders, and Even through preparations and advocacy groups. response to the pandemic, UNC This unit tested around 2,000 patients while also working to Health also moved forward its meet other health and emotional needs, connecting people to resources for food and financial assistance, providing coloring strategy to grow and serve more books for children, and distributing masks to anyone who communities across the state, needs one. This mobile testing service was featured in the New England Journal of Medicine and was cited over the summer promote greater equity in care, as a key component of UNC Health being awarded the 2020 advance research, and lead Latino Diamante Health and Science Community Award in recognition of extensive service and outreach to our state’s in education. Latino/Hispanic communities. COVID-19 Testing: From the Lab to the Parking Lot Increasing Knowledge of COVID-19 On March 16, only two weeks after North Carolina’s first As the pandemic caused a ramp down of labs across the nation reported case of COVID-19, UNC Medical Center launched in March, UNC School of Medicine faculty came together in-house testing for the virus. Led by Dr. Melissa Miller, UNC and stepped up with new collaborative projects studying the became one of the first academic labs in the nation with this biology and transmission of SARS-CoV-2, as well as the safety in house capability. Early in the pandemic, our testing capacity and efficacy of treatments and vaccines for the virus. was a vital asset, helping to track and understand the spread of the virus in our state. In acknowledgement of this work, UNC Health was recognized as the leading American university in the study Also in the spring, UNC Health launched drive-through of coronaviruses. The work being done across our institution COVID-19 testing at Respiratory Diagnostic Centers (RDCs) is happening on a foundation laid over the course of many across the state. The multi-point drive-through process was years of basic science research and experience in creating the developed for maximum efficiency — UNC Health even consulted infrastructure needed for large clinical trials. with Chick-fil-A on their design and processes. As patients move through, they are guided by UNC Health staff to fill out UNC labs led key research into remdesivir, the first FDA- necessary paperwork and ultimately receive their test. Once they approved treatment for COVID-19, and researchers are drive away, however, the process is really just beginning. In most now developing and studying other experimental antiviral cases, test results are available within 24 hours. Regardless of compounds and the use of monoclonal antibodies to test results, all patients tested through the RDCs receive daily treat COVID-19. follow-up messages either by phone or text to check on how they are feeling and if there are new or worsening symptoms. UNC researchers are utilizing next-generation sequencing This has provided reassurance for patients and also allowed for assays to characterize viral genetics and COVID-19 strains quick triage in the case of patients who are feeling worse and circulating in the population, enhancing our knowledge of the may require advanced care or hospital admission. Since the start virus and helping to maintain accurate, sensitive tests. of the pandemic, more than 140,000 patients have been seen at RDCs across North Carolina. Finally, UNC was a site for the Phase 3 clinical trial of the COVID-19 vaccine developed by Moderna. The pandemic has shined a bright light on health disparities and UNC Health recognized early on that there was a need to 2020 Annual Report 5 In addition to work on COVID-19 research, this year, the UNC However, as our community and our nation faced the reality School of Medicine celebrated another significant increase of racial injustice and violence, we made a commitment to in research funding, reaching just over $535 million.