March 16, 2020 Dear Partnership Advisory Group, New Hanover County Board of Commissioners, and New Hanover Regional Medical Center Board of Trustees: Thank you for the opportunity to respond to your request for proposal for a strategic partnership with New Hanover Regional Medical Center (NHRMC). We have long admired the quality care NHRMC provides for the citizens of southeastern North Carolina and your reputation for excellence. The partnerships UNC Health and NHRMC have fostered over many years have been productive for both of our systems and allowed each of us to further serve our missions. We have enjoyed learning in more detail about your organization through this RFP process. NHRMC’s co-workers, leaders, physicians and your community should be very proud of your health care system. To better understand NHRMC’s goals, we have attended your Partnership Advisory Group meetings and reviewed the materials provided to all respondents. After many discussions among our system leaders and our Board of Directors, we believe we understand NHRMC’s current situation and your desire to ensure your continued success for future generations. We would like to share our vision of how UNC Health could serve as a long-term partner. Our proposal reflects what we believe to be the best approach to meet the needs of NHRMC, your patients and your community. UNC Health proposes that we start our journey together through a significantly enhanced educational and research partnership, which we will refer to as our “academic partnership,” as well as a strengthened clinical partnership. This enriched relationship can evolve and expand over time, as NHRMC’s needs change. Please note, if management services and/or capital support are among your top requirements for a strategic partner, UNC Health has the necessary resources and is open to exploring those options. We have a successful history of partnering with hospitals via management services agreements, allowing for many benefits of UNC Health to be extended to our partners without a significant financial relationship or impact to local governance. We also participate in several equity partnerships ranging from minority partnerships, to joint ventures, to full ownership models. If you require a partner that can provide a significant capital infusion, UNC Health has the means and is prepared to offer such a partnership model. 1 | P a g e Who is UNC Health? UNC Health is a not-for-profit, integrated health care system owned by the State of North Carolina and based in Chapel Hill. Like NHRMC, we are a proudly public entity. The System was established by the Legislature in 1998 through N.C.G.S. 116-37, and was originally comprised of UNC Hospitals in Chapel Hill and the clinical patient care programs of the UNC School of Medicine (SOM). Today, UNC Health spans the state from Hendersonville to Jacksonville with 13 hospitals, hundreds of clinics, thousands of providers and more than 33,000 co-workers. We are North Carolina’s health system, caring for millions of patients from all 100 NC counties and beyond our state borders. We leverage the world-class research and education conducted at the UNC SOM in Chapel Hill and other campuses, translating those innovations to life-saving and life- changing therapies. Through our base within the UNC SOM, UNC Health maintains strong educational and clinical ties to the other health affairs schools including the UNC Adams School of Dentistry, the UNC School of Medicine Department of Allied Health Sciences, the UNC Eshelman School of Pharmacy, the UNC Gillings School of Global Public Health, and the North Carolina Health Education Centers (NC AHEC), among others. Mission and Values of UNC Health We believe UNC Health’s mission and values align well with those of NHRMC. Our mission is simple, but encompassing: Improve the health and well-being of North Carolinians. We are similar to NHRMC in that we foster a patient-first culture ensuring outstanding quality, compassion, and affordability for the patients we serve. We take a consumer-centric approach to improve access, convenience, and experience for patients and their families. As an innovative system, UNC Health is committed to our co-workers and our patients, and ensuring that our workforce is as diverse and talented as the communities we serve. We work to continuously develop innovative models to transform how we provide care. We understand that healthcare is constantly evolving, challenging us to always evaluate how we provide care and anticipate the future needs of our patients. 2 | P a g e Our Organizational Values are: Carolina Care – We care holistically about patients and each other; it is our privilege to serve the people of North Carolina; and we demonstrate kindness and compassion in every interaction. One Great Team – We are better together than apart; our effective collaboration is key to providing quality care; we are building an inclusive and equitable culture. Leading the Way – We make a difference by improving lives every day and training the next generation of leaders; our research is changing the world; we provide innovative care. It Starts with Me – Each of us takes ownership of, and accountability for, doing the right thing; we empower and trust each other to step up; we support each other and hold each other accountable in our work. UNC Health and NHRMC share cultures of transformation and readiness to move boldly into the future. In serving the people of North Carolina we each have an over-arching desire to ensure that all individuals we serve receive outstanding care and achieve the best health possible. ONE UNC Health UNC Health worked with our Board and our co-workers to redesign our organization via a new statewide strategy, operating model, and unified culture aimed at creating a more responsive, integrated health system. We call this new strategy “ONE UNC Health.” While we have much to offer through a proposed partnership, we also recognize that there is much to learn from an outstanding organization such as NHRMC. We welcome the opportunity to partner with NHRMC on this journey to improve the health and well-being of all North Carolinians. What differentiates UNC Health? We believe that UNC Health is a unique organization, bringing attributes to partnerships unmatched in North Carolina or beyond. Our prestige in public medical and health professional education, combined with a desire to collaborate with an established, well-regarded health system in southeastern North Carolina, makes us an ideal partner for NHRMC. UNC Health’s statewide footprint and our commitment to serve the people of North Carolina are unlike that of other potential partners. We bring an excellent national reputation paired with outstanding quality and performance in patient care, patient experience and provider engagement. We are also recognized as one of the state’s top employers. UNC Health shares our reputation for innovation and creativity with our partners. At the same time, we commit to maintaining local control through the governance of NHRMC and enhancing leadership development. We have a proven track record of protecting and expanding access to care in the communities we serve and pay careful attention to the wellbeing of our co-workers and providers. 3 | P a g e UNC Health’s Proposed Strategic Partnership with NHRMC Let us first acknowledge that this proposal is not the traditional approach UNC Health has used with past partnership offers. Based on our evaluation of the data and information provided, as well as what we learned at your Partnership Advisory Group meetings, we believe NHRMC is in an enviable position, which presents a unique opportunity for a nontraditional approach to partnership. UNC Health tailors all of its partnerships to meet the needs of the individual organization and the community it serves. We do not take a one-size-fits-all approach, but rather recognize the unique needs of our large and small partners throughout the state. Our partnership models include full ownership, joint ventures, management agreements, and partnering with both private not-for-profit and public county-owned hospitals. We believe that local entity leadership and boards should remain empowered and maintain local control, as they are best positioned to understand the needs of the local community. We value partnering with local leadership to achieve common goals in the best interest of the communities we serve. NHRMC is strong and capable of meeting the near-term challenges that face all health care organizations. Therefore, we believe the best current course of action is for NHRMC to remain independent and not pursue a sale, extensive management services agreement, or any other significant equity partnership that may require other terms or commitments that are less desirable right now. Our belief is based on what we know from the information made available and without any in-depth due diligence or discussions with NHRMC leaders and county leaders at this early stage in the process. From our perspective, the best approach to meet your Strategic Partnership goals is to rapidly expand and strengthen NHRMC’s academic and clinical partnerships with UNC Health. If it becomes necessary, we could then transition into a more integrated partnership arrangement over time. If the time comes when NHRMC requires material integration into a larger system, UNC Health will have earned the chance to be your chosen partner based on the foundation we have built through our expanded academic and clinical partnership. In addition to helping NHRMC and your community meet stated strategic goals, our proposed partnership would also have a positive economic impact on southeastern North Carolina. UNC Health engaged a third-party economic development consultant. Based on that firm’s analysis, the proposed partnership between UNC Health and NHRMC could generate $34 million in new total economic output in the region, $12 million in additional earnings, and support over 250 new jobs.