X UWHCA Board of Directors January 25, 2018, 1:30 - 4:30 PM Room H6/215 - Home | UW Health · 2018....

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UWHCA Board of Directors

January 25, 2018, 1:30 - 4:30 PM

Room H6/215

1:30 PM II. . Welcome and Call to Order of the Board MeetingWelcome and Call to Order of the Board MeetingMr. Gary Wolter

Meeting MinutesMeeting Minutes

Medical Staff Membership and Clinical PrivilegesMedical Staff Membership and Clinical Privileges

UWMF Board Faculty and Chair Director Selection for UWHCA ExecutiveUWMF Board Faculty and Chair Director Selection for UWHCA ExecutiveCommittee (non-voting members)Committee (non-voting members)

Attachment - Minutes from November 16, 2017

Attachment - Medical Staff Membership and Clinical Privileges

1:32 PM IIII. . Consent AgendaConsent AgendaMr. Gary Wolter

Approval

Presentation - UW Health Consolidated Financials - Preliminary YTDDecember 31, 2017

1:35 pm IIIIII. . UW Health Financial ReportUW Health Financial ReportMr. Robert Flannery

Informational/Discussion

Presentation - UW Health Investment Policy Statement Attachment - UW Health Investment Policy Statement

1:50 pm IVIV. . UW Health Investment Policy Statement and Investment Sub-CommitteeUW Health Investment Policy Statement and Investment Sub-CommitteeCharterCharterMr. John Litscher, Mr. Robert Flannery

Approval

Attachment - Dr. Elizabeth Trowbridge Bio

Resolution - UWMF Board Faculty and Chair Director Selection forUWHCA Executive Committee (Non-Voting Members)

Attachment - 36th Annual J.P. Morgan Healthcare Conference - KeyTakeaways

Resolution - UW Health Investment Committee Policy and Charter

2:10 pm VV. . Closed SessionClosed Session Motion to enter into closed session pursuant to Wisconsin Statutes section19.85(1)(e), for the discussion of the following confidential strategic matters,which for competitive reasons require a closed session: discussion offinancial matters, contractual obligation for former UWHC Board, healthcare reimbursement audit, UW Health/UnityPoint Health-Meriter IntegrationUpdate, and Department of Neurosurgery Overview; pursuant to WisconsinStatutes section 146.38, for the review of the Patient Safety and Quality

UWHCA Board of Directors - January 25, 2018UWHCA Board of Directors - January 25, 2018

AgendaAgenda

Page 4

Page 6

Page 15

3

Page 25

Page 42

Page 45

Page 56

Page 77

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FYI Attachment - UW OTD CY18 Quality Assessment and PerformanceImprovement Plan

VIIVII. . FYI Attachments (Please review)FYI Attachments (Please review)

Informational

Committee report and the Joint Commission Update; and pursuant toWisconsin Statutes section 19.85(1)(g), to confer with legal counselregarding these and other matters.

4:30 PM VIVI. . AdjournAdjourn

FYI Attachment - UW OTD CY17 Annual Summary Report

Page 79

Page 91

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Attachment

Dr. Elizabeth Trowbridge Bio

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Dr. Elizabeth (Betsy) Trowbridge is the Phillip August and Sarah Neely Herrmann Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. She graduated from the University of Wisconsin-Madison Medical School in 1991. She completed her residency and Chief Residency in Internal Medicine at the University of Wisconsin Hospital in Madison. Dr. Trowbridge serves as Division Chief for General Internal Medicine, as well as Associate Vice Chair of Primary Care for the Department of Medicine. She continues to practice General Internal Medicine at 20 S Park St. She has previously served on the Meriter Hospital Board of Directors. She has also previously served as the senior associate program director for the Internal Medicine Residency training program at UWHC. She is one of the leaders in the primary care redesign effort at UW Health. This has included developing an innovative population-based compensation model for primary care. Dr. Trowbridge is the co-director of PATH (Primary Care Academics Transforming Healthcare), a multi-disciplinary writing group of physicians and change leaders at UW Health who write about UW Health redesign efforts. Dr. Trowbridge completed a fellowship in the prestigious Hedwig van Ameringen ELAM (Executive Leadership in Academic Medicine) program at Drexel University in 2017. This program is directed at women leaders in academic medical centers. She was awarded the Helen Dickie Award for Outstanding Woman Physician from the American College of Physicians in 2017. Dr. Trowbridge currently serves on the University of Wisconsin Medical Foundation Board of Directors. She also serves on the Green Bay Packers Board of Directors.

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Attachment

Open Session Minutes November 16, 2017

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UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY

Minutes of Board of Directors Meeting

Open Session November 16, 2017, 1:30 PM

Room H6/215

A meeting of the Board of Directors of University of Wisconsin Hospitals and Clinics Authority (“UW Health”) was held at 600 Highland Avenue, Room H6/215, Madison, WI, pursuant to notice duly given. Board Chair, Gary Wolter, chaired the meeting, Kelly Wilson, Chief Legal Officer, served as Secretary of the meeting.

UWHCA BOARD MEMBERS PRESENT: Gary Wolter (Chair), Dean Robert Golden (Vice Chair Chair), Rep. Mark Born, Dr. Thomas Grist, Regent Tim Higgins, Andrew Hitt, John Litscher, Regent Regina Millner, Regent Janice Mueller, Senator Luther Olsen, Lisa Reardon, Pablo Sanchez, Dean Linda Scott (via telephone) UWHCA BOARD MEMBERS EXCUSED: Chancellor Rebecca Blank, Michael Heifetz, David Ward ALSO PRESENT BY INVITATION: UWMF LIAISON BOARD MEMBERS (Non-Voting): Patricia Brady, , Dr. Jon Matsumura, Dr. Richard Page UNITYPOINT HEALTH-MERITER LIAISONS (Non-Voting): Dr. Margaret Noreuil UW HEALTH STAFF PRESENT: Dr. Alan Kaplan, Chief Executive Officer; Shawn Arneson, Director, Guest and Valet Services; Bob Flannery, Senior Vice President/Chief Financial Officer; Liz Douglas, VP Facilities and Support Services; Dr. Susan Goelzer, Associate Dean of Graduate Medical Eduction (Designated Institutional Official); Tina Whitehorse, Executive Assistant to the CEO; Kelly Wilson (Secretary) GUEST: Jeremy Zabel, RSM Partner 1. Call to Order

Chair Gary Wolter called the open session of the Board of Directors meeting to order at 1:30 p.m. Roll call was taken and a quorum was present. 2. ACTION: Approval of UWHCA Consent Agenda

Chair Wolter requested a motion to approve the items on the Consent Agenda, including:

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UWHCA September 28, 2017 Open Session Minutes; Medical Staff Membership and Clinical Privileges; Resolution approving Madison Surgery Center Board Appointment [Resolution 18-011]; University of Wisconsin Medical Foundation (UWMF) – Faculty Director Slate of Candidates; Resolution approving UWMF Board of Directors Chair Director [Resolution 18-012].

Upon a motion duly made by Thomas Grist, MD, seconded by Mr. Litscher, and unanimously carried, the Board approved the Consent Agenda, including the resolutions in the form attached collectively as Attachment 1. 3. ACTION: Resolution of Gratitude for Service of Ms. Lisa Reardon Chair Wolter read the resolution of gratitude for service in appreciation of Ms. Lisa Reardon. Upon a motion made by Dean Golden, seconded by Regent Mueller and unanimously carried, the resolution in the form attached hereto as Attachment 2 extending University of Wisconsin Hospitals and Clinics Authority heartfelt gratitude to Ms. Reardon for her leadership, exemplary work and loyal support the UWHCA. [Resolution 18-013] 4. GME Annual Institutional Air (AIR) Report Dr. Susan Goelzer presented the GME Annual Report. The Accreditation Council of the Graduate Medical Education (ACGME) requires an annual report to the Medical Staff and UWHCA Board. The report covered activities between July 1, 2016 and June 30, 2017. UWHC sponsors 70 ACGME Accredited Residency and Fellowship Programs. New ACGME Accredited Programs include: Adult Cardiothoracic Anesthesiology, Colorectal surgery, Surgical Oncology, Gynecology Oncology, Maternal Fetal Medicine and Pain Medicine. The institution and all of its programs have accreditation without significant citation. The Aggregate Institutional Overall Evaluation is 4.6/5.0, with reference to a national mean of 4.45.

Dr. Goelzer reviewed ACGME Survey Data, GME Growth, and GME Financial Statements. She reviewed Clinical Environment Improvement (ACGME CLER) and focused on faculty and resident well-being noting new ACGME requirements include the following resources: confidential counseling, work/life balance, fatigue, burnout, education and support for physicians at risk of self-harm.

In closing, Dr. Goelzer reviewed the 2017-2018 GME action plan.

Dr. Goelzer was excused from the meeting.

5. InnTowner, LLC Update In December 2012, the Board approved a capital investment to purchase the InnTowner Hotel, Ms. Liz Douglas and Mr. Shawn Arneson were present to provide an update on the investment. Ms. Douglas provided background information pertaining to the initial purchase of the InnTowner Hotel including mission and goals. Since 2012, a total of $4M has been invested to renovate the Facility (UW Health funded $1.9M; the remainder was funded from the wholly-owned InnTowner, LLC). In FY17, inpatient avoidable days were approximately 570 room nights (attributable to organ and bone marrow transplant room nights), with increases projected due to new programs. Additional service to the UW Health Community include: support to Ronald McDonald House with capacity management (548 room nights); UW Health employees in time of need (160 room nights); support staff relocation with temporary housing at reduced room rate, and we are

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expanding to serve UPH-Meriter patients. Ms. Douglas reviewed financial information for the InnTowner, LLC and planned capital improvements in FY18. Ms. Douglas and Mr. Arneson were excused from the meeting.

6. Year-End FY17 Audit Report / Governmental Accounting Standards Board (GASB) Statement 68

Mr. Flannery reported the UWHCA Audit Committee met on November 6, 2017 to review the UW Health FY17 Audit Report – noting no issues during the audit review process, the Audit Committee unanimously accepted the Audit report as presented.

Mr. Jeremy Zabel, RSM was present to provide a brief synopsis of the FY17 Audit and address questions from the Board. Mr. Zabel highlighted information regarding GASB Statement 68 No. 75 Accounting and Financial Reporting for Postemployment Benefits Other than Pensions. He stated Statement 75 requires measurement and reporting of other postemployment benefits in a manner similar to pensions and must be adopted no later than the year ending June 30, 2018. He noted management is evaluating the effect this statement will have on the UW Health financial statements. Mr. Zabel was excused from the meeting.

7. UW Health Financial Report

Mr. Flannery reviewed the preliminary FY18 Consolidated Financials for YTD period ending September 30, 2017 reviewing YTD operating margin, admissions, clinic visits, surgeries, ER visits, UWMF w/RVU’s and Primary Care Volumes. He highlighted operating results with the JOA, Volume Statistics, Non-Operating Revenue and YTD Performance Ratios.

8. Closed Session

There being no other matters for the open session, Chair Wolter proposed to take the meeting into closed session pursuant to Wisconsin Statutes section 19.85(1)(e), for the discussion of the following confidential strategic matters, which for competitive reasons require a closed session: discussion of Financial Matters, UW Health Strategic Plan, Senate Bill 154 Update and Climate and Culture Issue in a Clinical Department; pursuant to Wisconsin Statutes section 146.38, for the review of the Patient Safety and Quality Committee report and the Joint Commission Report; and pursuant to Wisconsin Statutes section 19.85(1)(g), to confer with legal counsel regarding these and other matters. Senator Luther Olsen moved to go into closed session; Mr. John Litscher seconded the motion; there was a unanimous roll call vote approving entering into closed session. The following members voted for the motion: Chair Wolter, Vice Chair Golden, Rep. Mark Born, Dr. Thomas Grist, Regent Tim Higgins, Andrew Hitt, John Litscher, Regent Regina Millner, Regent Janice Mueller, Senator Luther Olsen, Lisa Reardon, Pablo Sanchez, and Dean Linda Scott. The meeting was adjourned in closed session.

Respectfully Submitted,

Kelly Wilson, Secretary

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ATTACHMENT 1

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RESOLUTION OF

THE BOARD OF DIRECTORS OF


Approval of Director of Madison Surgery Center, Inc.

WHEREAS, University of Wisconsin Hospitals and Clinics Authority (“UWHCA”) is a Member of Madison Surgery Center, Inc. (“MSC”); and

WHEREAS, Section 3.02 of MSC’s Amended and Restated Bylaws (the “MSC Bylaws”) provides that each Member shall be entitled to appoint two (2) members of the Board of Directors; and

WHEREAS, Dr. Bob Pearce (“Dr. Pearce”) has resigned as a director of MSC thereby creating a vacancy in one of the two Board of Directors seats to be appointed by UWHCA; and

WHEREAS, MSC’s management has recommended to the UWHCA Chief Executive Officer that Dr. Roland Vega (“Dr. Vega”) be appointed to fill the seat vacated by Dr. Pearce,and the UWHCA Chief Executive Officer agrees with that recommendation; and

WHEREAS, based on the recommendation of MSC’s management and the UWHCA Chief Executive Officer, and upon consideration of other relevant factors, the Board has determined that it is in the best interests of UWHCA to appoint Dr. Vega to the MSC Board;

NOW, THEREFORE, BE IT RESOLVED, that pursuant to its rights under Section 3.02 of the MSC Bylaws, UWHCA hereby appoints Dr. Vega to fill the MSC Board of Directors seat vacated by Dr. Pearce, to hold office until the expiration or his term or until the appointment and qualification of his successor, or until his earlier resignation or removal in accordance with the MSC Bylaws;

FURTHER RESOLVED, the UWHCA Chief Executive Officer, or his delegates, are hereby authorized, empowered and directed to take all such actions as may be considered proper and convenient to carry out the foregoing resolutions and any and all acts heretofore taken by the UWHCA Chief Executive Officer, or his delegates in connection with the foregoing resolutions are hereby ratified and confirmed.

RESOLUTION 18-011

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RESOLUTION OF THE BOARD OF DIRECTORS OF


Approving Richard Page, M.D. (Medicine) to Serve as “Chair Director” on UWMF Board of Directors

November 16, 2017

WHEREAS, the University of Wisconsin Hospitals and Clinics Authority (“UWHCA”)is the sole corporate member of University of Wisconsin Medical Foundation, Inc. (“UWMF”), with such powers over the governance of UWMF as are provided in the “Bylaws of the University of Wisconsin Medical Foundation, Inc., Amended and Restated Effective July 1, 2015” (“UWMF Bylaws”); and

WHEREAS, the UWMF Bylaws provide that the UWMF Board of Directors shall include four (4) “Chair Directors,” who are chairs of a Clinical Department of the University of Wisconsin-Madison School of Medicine and Public Health, to be selected by the UWMF Council of Chairs and approved by the UWHCA Board of Directors (“Authority Board”); and

WHEREAS, the UWMF Council of Chairs has selected Richard Page, M.D. (Medicine)to serve an additional term as Chair Director for a three (3) year term beginning January 1, 2018;

WHEREAS, the Authority Board has determined that Dr. Richard Page is fully qualified to serve as Chair Director on the UWMF Board of Directors, and has further determined that it is in the best interests of the UWHCA and UWMF, to have Dr. Richard Pageserve in that capacity;

NOW, THEREFORE, BE IT RESOLVED, that the Authority Board approves the selection of Richard Page, M.D., to serve as Chair Director member of the UWMF Board of Directors for an additional three (3) year term beginning January 1, 2018.

RESOLUTION 18-012

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ATTACHMENT 2

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In Recognition of the Service of Ms. Lisa Reardon

November 16, 2017

WHEREAS, Ms. Lisa Reardon has served with distinction, dedication and unwavering loyalty as a member of the Board of Directors of the University of Wisconsin Hospitals and Clinics Authority (UWHCA) since 2012;

WHEREAS, as a member of the Audit Committee, Finance Committee and Executive Compensation Committee, Ms. Reardon has been a tireless steward of ensuring: delivery of high quality health care; an environment suitable for instructing medical and other health professionals; support for applying the advances of research in the delivery of health care to alleviate human suffering, promote health and prevent disease; and support of health programs and personnel throughout the state and region in the delivery of health care.

WHEREAS, during her tenure, Ms. Reardon was a strong supporter of the strategic vision of UWHCA, as it strengthened and cemented its regional presence, both through organic growth as well as through a variety of strategic affiliations and ventures, enabling it to succeed in the ever-changing health care marketplace;

WHEREAS, Ms. Reardon provided invaluable guidance, support, and leadership during an important time in UWHCA’s history, a time of integration between UWHCA and UW Medical Foundation to create an integrated health care delivery system; and

WHEREAS, Ms. Reardon is an honored and trusted friend of UWHCA and has served UWHCA in true fulfillment of its mission, vision, and values;

NOW THEREFORE BE IT RESOLVED that the Board of Directors and the management of the University of Wisconsin Hospitals and Clinics Authority extend their heartfelt gratitude to Ms. Lisa Reardon for her leadership, exemplary work and loyal support of the UWHCA.

RESOLUTION 18-013

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Attachment

Medical Staff Membership and

Clinical Privileges

January 2018Medical Board: January 2018

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Resolution

UWMF BoardFaculty and Chair Director Selection

for UWHCA Executive Committee

(Non-Voting Members)

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Approving Richard Page, M.D. and Elizabeth Trowbridge, M.D. to Serve as on UWHCA Executive Committee

January 25, 2018

WHEREAS, the University of Wisconsin Hospitals and Clinics Authority (“UWHCA”)

is the sole corporate member of University of Wisconsin Medical Foundation, Inc. (“UWMF”), with such powers over the governance of UWMF as are provided in the Bylaws of the University of Wisconsin Medical Foundation, Inc., Amended and Restated Effective July 1, 2015 ( the “UWMF Bylaws”); and

WHEREAS, pursuant to the Integration Agreement, UWHCA amended its Bylaws to permit the Foundation to nominate three individuals to serve as non-voting members of the UWHCA Executive Committee (the “Executive Committee”)

nominated Richard Page, MD to serve an additional three (3) year term and nominated Elizabeth Trowbridge, MD to serve a three (3) year term on the Executive Committee, each such term beginning January 1, 2018; and

WHEREAS, the Authority Board has determined that Dr. Richard Page and Dr.

Elizabeth Trowbridge are fully qualified to serve as UWMF Board Directors representatives on the Executive Committee , and has further determined that it is in the best interests of the UWHCA and UWMF, to have Dr. Richard Page and Dr. Elizabeth Trowbridge serve in that capacity;

NOW, THEREFORE, BE IT RESOLVED, that the Authority Board approves the nomination of Richard Page, M.D. and Elizabeth Trowbridge, M.D. to serve as UWMF Board representatives on the Executive Committee for a three (3) year term beginning January 1, 2018.

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UW Health Financial Reports

FY18

Consolidated Financial Review

Preliminary Year to Date December 31, 2017

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UW Health Current Month Operating Margin

December 31, 2017

• Combined total includes eliminations and the Academic support included as an operating expense.

• ** Combined HC/MF without eliminations

2.4%

0.2%

1.8%

1.2% 1.7%

3.5%

1.0%

2.8%

-0.8%

2.2%

1.0%

6.3%

2.6%

1.0%

2.3%

UWHCA UWMF Combined HC/MF ** SAHS /RDI Total *

Actual Budget Prior Year

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UW Health YTD Operating Margin

December 31, 2017

• Combined total includes eliminations and the Academic support included as an operating expense.

• ** Combined HC/MF without eliminations

2.4%

1.9%

2.3%

3.0%

2.4%

4.1%

1.0%

3.2%

2.7%

3.1%

4.9%

2.4%

4.2%

1.5%

3.7%

UWHCA UWMF Combined HC/MF ** SAHS /RDI Total *


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Admissions – YTD December 31, 2017

4

Entity Actual Budget Variance Variance % Prior Year Variance Variance %

University Hospital 13,163 13,357 (194) -1.5% 13,058 105 0.8%

AFCH 1,916 2,006 (90) -4.5% 1,916 - 0.0%

TAC 1,543 1,996 (453) -22.7% 1,513 30 2.0%

Total UWH MADISON 16,622 17,359 (737) -4.2% 16,487 135 0.8%

SAHS 7,788 8,467 (679) -8.0% 8,759 (971) -11.1%

Meriter 7,551 7,499 52 0.7% 7,473 78 1.0%Total System including JOA 31,961 33,325 (1,364) -4.1% 32,719 (758) -2.3%

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Clinic Visits – YTD December 31, 2017

5


University

Hospital 252,227 247,000 5,227 2.1% 246,557 5,670 2.3%

AFCH 61,799 63,346 (1,547) -2.4% 60,870 929 1.5%

TAC 34,538 32,338 2,200 6.8% 31,426 3,112 9.9%

Total UWH

MADISON 348,564 342,684 5,880 1.7% 338,853 9,711 2.9%

SAHS 213,465 214,730 (1,265) -0.6% 198,597 14,868 7.5%

Meriter 105,680 119,977 (14,297) -11.9% 106,579 (899) -0.8%Total System

including JOA 667,709 677,391 (9,682) -1.4% 644,029 23,680 3.7%

UWH Madison does not include UWMF clinic visits (Work is being done to include in future months)

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Surgeries – YTD December 31, 2017

6


HC 12,218 12,066 152 1.3% 12,097 121 1.0%

AFCH 3,578 3,289 289 8.8% 3,226 352 10.9%

TAC 3,247 3,694 (447) -12.1% 3,390 (143) -4.2%

Total UWH

MADISON 19,043 19,049 (6) 0.0% 18,713 330 1.8%

SAHS 4,652 4,593 59 1.3% 4,520 132 2.9%

Meriter 3,846 4,330 (484) -11.2% 4,081 (235) -5.8%

MSC 5,908 5,871 37 0.6% 5,905 3 0.1%

TSC 558 529 29 5.5% 579 (21) -3.6%Total System

including JOA 34,007 34,372 (365) -1.1% 33,798 209 0.6%

0.0%

1.3%

-11.2%

0.6%

5.5%

-1.1%

1.8% 2.9%

-5.8%

0.1%

-3.6%

0.6%

UWH MADISON SAHS MERITER MSC TSC TOTAL

Budget

Prior Year

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ER visits – YTD December 31, 2017

7


UWH MADISON 38,219 36,035 2,184 6.1% 35,139 3,080 8.8%

SAHS 34,551 35,753 (1,202) -3.4% 35,929 (1,378) -3.8%

Meriter 19,329 21,896 (2,567) -11.7% 21,204 (1,875) -8.8%Total System including JOA 92,099 93,684 (1,585) -1.7% 92,272 (173) -0.2%

6.1%

-3.4%

-11.7%

-1.7%

8.8%

-3.8%

-8.8%

-0.2%

UWH MADISON SAHS MERITER TOTAL

Budget

Prior Year

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UWMF wRVU’s through December 31, 2017

Work Relative Value Units (wRVUs) are a measure developed by CMS as part of the Medicare reimbursement formula for physician

services. wRVUs reflect the time, skill, training and intensity to provide a given service. For example, a surgical code will typically have

a higher value (and corresponding payment) than a routine appointment code. wRVUs are also used by UW Health and other practice

plans to measure provider productivity (volume). When payors determine payments based on RVU’s, they typically include two

additional RVU components to reflect the practice expense costs (technical) and malpractice insurance costs.

*Two fewer business days in July FY17 compared to July FY16

Specialty care wRVUs increased 4.7%

and Primary care wRVUs decreased 2.7% YTD Variance

8

365 356

1,868 1,946

0

500

1,000

1,500

2,000

2,500

wRVUs FY17 wRVUs FY18

Tho

usa

nd

s

Primary Care

Specialty Care

-3.2%

3.0%

-4.0%

-3.0%

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

Versus budget

Versus prior year

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UW Health Primary Care Volumes

Clinic visits year over year are down by 0.8% while non face-to-face encounters are up by 2.8%. Clinical

Physician FTE are down by 5.8% and head count is up by 0.5% while number of active panels are up by 0.4%.

Note: Includes Fam Med (including Wingra ACHC), GIM & GPAM excluding Augusta & Eau Claire. Clinic visits are arrived or completed

appointments that include nurse only visits. Non face-to-face encounters include MyChart, Telephone and Refill encounters logged in

HealthLink. Other includes all provider types not listed as MD, DO, NP or PA. Clinical FTE APP and Head Count APP are updated every 6

months. Active Panel are for MD/DO faculty only.

Data source: Ambulatory Encounters dashboard and Panel Activity Report. of 98

Summary of Enterprise-Wide December 31, 2017 YTD Operating Results with JOA

Volume Margin

10

2.4%

3.1%

3.7%


-4.1% -1.4% -1.1% -2.3%

3.7% 0.6%

-6.0%-4.0%-2.0%0.0%2.0%4.0%6.0%

Adult and PedsAdmissions Clinic Visits Surgeries

Versus budget Versus prior year

Actual YTD Budget YTD Actual YTD Variance Vs.

Dec 2017 Dec 2017 Dec 2016 Budget

Operating Revenue 1,551.3$ 1,550.6$ 1,490.3$ 0.0%

Operating Expenses:

Salaries and fringe benefits 855.9 829.5 820.1 -3.2% Medical materials and supplies 130.6 138.2 129.5 5.5% Pharmaceuticals 194.8 187.6 172.1 -3.9% Other expenses 292.1 313.0 277.7 6.7% Academic Advancement Support 34.5 34.2 35.2 -1.1% Results of JOA 5.9 - - 100.0%

Total Operating Expenses 1,514.0 1,502.4 1,434.5 -0.8%

Operating Income 37.4 48.2 55.8 -22.5%

Nonoperating Income * 64.0 22.4 22.5 185.1%

Net Income 101.3$ 70.6$ 78.3$ 43.5%

*Includes Income Tax (Expense)

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Enterprise-Wide December 31, 2017 YTD Performance Ratios

11

Favorable

Direction FY 18

S&P "AA-"

Rated (1)

Moodys "Aa3"

Rated (2)

Operating Margin (including Academic Support) 2.4% 3.3% 3.7%

Total Margin 6.4% 4.4% 6.6%

Days Cash on Hand * (including Academic Support) 202 220 234

Days in Accounts Receivable ** 41 48 49

Long Term Debt to Capitalization 20.4% 30.1% 29.5%

Operating Cash Flow 6.9% 9.6% 8.9%

Cash-to-Debt 261.8% 189.6% 202.7%

Compensation Ratio of NPR 57.2% 57.1%

* excludes provision for bad debt and retiree health insurance

** average for 5 months

(1) S&P's 2016 financial ratios based on 38 obligators rated "AA-" by S&P. Based on 2016 audited financials.

(2) Moody's 2016 financial ratios based on 40 "Aa3" rated hospitals. Based on 2015 audited financials.

Performance Ratios

Industry Comparisons

Healthcare System

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UW Health Days in AR

Year-to-Date December 31, 2017

12

UW Health-

Madison Net

Accounts

Receivable

Net Days

Revenue

Outstanding

RDI Net

Accounts

Receivable

Net Days

Revenue

Outstanding

Total Net

Accounts

Receivable

Net Days

Revenue

Outstanding

Jan-17 296,177,717 45.2 71,236,845 59.7 367,414,562 47.5

Feb-17 296,479,920 44.9 72,639,795 60.8 369,119,715 47.3

Mar-17 288,757,782 43.4 72,976,179 60.9 361,733,961 46.1

Apr-17 286,869,046 43.1 77,483,035 65.0 364,352,081 46.5

May-17 285,199,216 42.7 76,105,961 63.5 361,305,177 45.9

Jun-17 285,144,263 42.5 78,535,519 65.3 363,679,782 46.0

Jul-17 284,909,763 43.3 75,119,096 64.4 360,028,859 46.5

Aug-17 284,329,538 41.8 76,236,791 62.2 360,566,329 45.0

Sep-17 285,069,526 42.1 78,080,748 64.1 363,150,274 45.5

Oct-17 289,282,131 42.2 72,066,186 58.6 361,348,317 44.7

Nov-17 280,385,152 40.7 63,469,574 51.4 343,854,726 42.4

Dec-17 268,888,426 39.0 61,713,446 49.7 330,601,872 40.6

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UW Health Non-Operating Revenue

Year-to-Date December 31, 2017 (Amount in $$ Thousands)

13

Actual YTD Budget YTD $ Variance % Variance Actual YTD $ Variance % Variance

Dec 2017 Dec 2017 Vs. Budget Vs. Budget Dec 2016 Vs. Prior Yr Vs. PY

Earned Investment Income 17,354,084 13,335,225 4,018,859 30.1% 12,631,572 4,722,512 37.4%

Equity in earnings of joint ventures 8,191,365 6,546,030 1,645,335 25.1% 1,174,816 7,016,549 597.2%

Unrealized gain (loss) on investments 34,158,721 1,345,470 32,813,251 2438.8% 3,952,636 30,206,085 764.2%

Other, net * 4,284,118 1,216,788 3,067,330 252.1% 4,760,247 (476,129) -10.0%

Total nonoperating revenues (expenses), net 63,988,288 22,443,514 41,544,774 185.1% 22,519,271 41,469,017 184.1%

* includes Income Tax (Expense)

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UW Health Joint Venture Results

(Amount in $$ Thousands)

14

Actual YTD Budget YTD $ Variance % Variance Actual YTD $ Variance % Variance

Dec 2017 Dec 2017 Vs. Budget Vs. Budget Dec 2016 Vs. PY Vs. PY

MUHL 2,763 (323) 3,086 -957% (4,455) 7,218 -162%

Chartwell 1,987,642 844,411 1,143,231 135% 1,097,402 890,240 81%

MERI 27,657 - 27,657 8,513 19,144 225%

UHC 1,664,778 512,075 1,152,703 225% (3,903,966) 5,568,744 -143%

Madison Surgery Center 2,373,842 2,109,044 264,798 13% 1,689,245 684,597 41%

Generations (331,063) (353,025) 21,962 -6% (467,853) 136,790 -29%

Madison Rehab Hospital 1,217,886 1,820,002 (602,116) -33% 1,013,179 204,707 20%

Wisconsin Dialysis 880,986 1,298,829 (417,843) -32% 1,099,544 (218,558) -20%

Inntowner - - - 998 (998) -100%

Transformations Surgery Center 24,846 9,606 15,240 159% 170,376 (145,530) -85%

Wisconsin Sleep 199,825 278,215 (78,390) -28% 245,228 (45,403) -19%

ACO - - - - -

Madison Medical Center 141,728 27,196 114,532 421% 226,605 (84,877) -37%

Other 475 - 475 - 475

Total 8,191,365 6,546,031 1,645,335 25% 1,174,816 7,016,549 597%

UW Health Madison

Six Months Ended December 31, 2017

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UW Health Consolidating Balance Sheet

YTD December 31, 2017

15

UWHCA UWMF

Total UWHCA and

UWMF SAHS/RDI

UW Health

Consolidated

Cash & Investments

Unrestricted 1,025,969,276 252,619,395 1,278,588,671 288,608,174 1,567,196,845

Restricted by Trustee & Donors 13,619,079 - 13,619,079 - 13,619,079

Accounts Receivable 194,457,961 74,430,465 268,888,426 61,713,446 330,601,872

Property, Plant & Equipment, Net 778,367,530 84,784,838 863,152,368 320,715,924 1,183,868,292

Other Assets & Deferred Outflows of Resources 365,011,762 94,385,068 430,925,752 86,255,498 517,039,463

Total Assets & Deferred Outflows of Resources 2,377,425,608$ 506,219,766$ 2,855,174,296$ 757,293,042$ 3,612,325,551$

Current Liabilities 306,102,940 127,545,605 405,177,467 109,243,190 514,278,870

Long-term Debt & Deferred Inflows of Resources 640,304,393 50,390,000 690,694,393 144,759,535 835,453,928

Net Position

Unrestricted 1,419,639,855 328,284,161 1,747,924,016 493,676,671 2,241,600,687

Restricted 11,378,420 - 11,378,420 9,613,646 20,992,066

Total Liabilities, Deferred Inflows of Resources &

Net Position 2,377,425,608$ 506,219,766$ 2,855,174,296$ 757,293,042$ 3,612,325,551$

Elimination Entries are not displayed but are part of the Consolidated Numbers

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UW Health Consolidating Income Statement YTD December 31, 2017

16

UWHCA UWMF

Total UWHCA &

UWMF SAHS/RDI

UW Health

Consolidated

Net Patient Service Revenue (net of provision for bad

debts) 906,158,011 363,880,426 1,270,038,437 228,461,876 1,496,693,125

Other Revenues 14,399,891 3,573,173 17,973,064 36,662,803 54,635,867

Total Revenue 920,557,902 367,453,599 1,288,011,501 265,124,679 1,551,328,992

Operating Expenses:

Salaries & Benefits 403,600,219 253,823,574 723,219,246 132,698,669 855,917,915

Supplies and Other Expenses 280,057,365 56,213,327 270,475,239 89,984,849 358,652,899

Pharmaceuticals 153,258,265 21,432,058 174,690,323 20,103,572 194,793,895

Interest 9,159,304 241,616 9,400,920 1,601,467 11,002,387

Depreciation 42,214,899 4,174,737 46,389,636 12,663,070 59,052,706

Total Operating Expenses 888,290,052 335,885,312 1,224,175,364 257,051,627 1,479,419,803

Operating Income 32,267,850 31,568,287 63,836,137 8,073,052 71,909,189

Academic Advancement Support (non-operating) (10,075,953) (24,473,447) (34,549,400) - (34,549,400)

Income Before Other Other Non-Operating Activity 22,191,897 7,094,840 29,286,737 8,073,052 37,359,789

Total Non-operating Revenue and Income Tax Expense 34,473,044 18,044,520 52,517,564 11,470,724 63,988,288

Net Income 56,664,941 25,139,360 81,804,301 19,543,776 101,348,077

Elimination Entries are not displayed by are part of the Consolidated Numbers

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UW Health Financial Structure

Affiliation Agreement

University of Wisconsin Hospitals and Clinics Authority

University of Wisconsin Medical Foundation

Regional Division, Inc.1

Swedish American Health System

Equity-Based Joint Ventures

Majority-Owned Non-Consolidated

Ventures

Non-Consolidated Joint Ventures

University Hospital American Family Childrens Hospital

The American Center Ambulatory Clinics

InnTowner, LLC

Faculty Practice Plan 17 Clinical Departments

Ambulatory Clinics

SA Hospital Rockford SA Hospital Belvidere

SA Medical Group Regional Cancer Center

SA Home Health Other Entities

University Health Care, Inc.2

Unity/GHP Insurance Companies

Madison Surgery Center Wisconsin Dialysis

Chartwell Enterprises Generations

UW Health ACO

UWH Rehabilitation Hospital Madison United Linen

Madison Environmental Transformations Surgery Center

Wisconsin Sleep Madison Medical Center

1 Includes minority investments in UW Cancer Center Johnson Creek and AboutHealth

2 Includes Health Professionals of Wisconsin and eCare of Wisconsin

These entities were integrated on July 1, 2015.

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1

Key Takeaways from the 36th Annual J.P. Morgan Healthcare Conference: Not-for-Profit Healthcare

Last week, more than 10,000 registered participants descended on San Francisco for the 36th annual J.P.Morgan Healthcare conference. In this, the eighth year of the Not-for-Profit (“NFP”) track, we heard from 22 of the country’s leading NFP health systems and insurers who shared their insights and strategies with standing-room-only crowds. Much discussion focused on the impact of tax reform and limitations on advance refundings, which led to the acceleration of more than $20B of tax-exempt healthcare issuance into late 2017 (vs. less than $4B in 2016) and brought added emphasis to healthcare systems’ defense of their tax-exempt status. While operational headwinds persist and elements of the ACA are dismantled, healthcare systems are going to face new sources of competition which aim to disintermediate providers, such as CVS/Aetna and United Healthcare/Davita Medical Group, among others. While strategies, competitive environments and demographics vary among systems, several key themes emerged from the myriad presentations and meetings last week:

Top 10 Themes from the Not-for-Profit Track

1. Focus on market essentiality drives strategy: Successful systems have continuously invested in developing leading market positions in every market they serve and in offering a range of sites of care. Larger systems have actively managed their portfolio where achieving this position is not possible; the “stigma” of divestiture is gone, even for faith-based organizations.

2. Consolidation and regional growth accelerating: The M&A trends of the past several years continue as players such as Baylor Scott & White expand their regional positions. NFP providers are increasingly acquiring assets of their more challenged investor-owned competitors, particularly Community Health Systems and Tenet Health. State borders no longer constrain markets or regional systems, as demonstrated by the Advocate/Aurora merger and Intermountain’s partnership with a Nevada medical group.

3. Mega-mergers are happening in NFP healthcare, but they are not easy: The alignment of Dignity Health and Catholic Health Initiatives will create the largest NFP healthcare system outside of Kaiser Permanente, with more than $30B in annual revenue. The systems announced that the integration would be a multi-year process following regulatory approval, which is expected this year. 2018 could bring additional large scale merger activity.

4. Healthcare systems actively addressing the social determinants of health: Many of the presenting systems have refreshed their mission, vision and strategy statements to encompass a focus on maintaining community health and getting to the root causes of sickness and chronic disease. More systems than ever focus on a broader definition of health, to include mental health support and social services like Geisinger’s fresh food pharmacy in Scranton or Florida Blue’s social service pilots. Leading health systems are leveraging data to link zip codes and geographic location to influence patient treatment.

5. Taking risk is still risky, but the underwriting cycle improved: While several systems promptly exited the health insurance business after entering the space, those that maintained their insurance subsidiaries - like Partners with Neighborhood Health Plan -- performed better in 2017. Systems with a longer history of integration – such as Intermountain, Geisinger and Baylor Scott & White – still have the advantage in managing risk. For other systems, value based contracts continue to represent a fairly small percentage of total revenues, but the share is growing.

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6. Volumes trends are down and improving operational efficiency is non-negotiable: Most markets are

experiencing lower inpatient and surgical volumes; those that are growing volumes are generally doing it by taking share from competitors. All systems, large and small, are focused on reducing cost and extracting operational efficiencies as they redesign processes and manage labor expenses. As care shifts to the outpatient setting, insurers challenge reimbursement, high deductible plans proliferate and the bad debt burden grows, systems must manage the cost equation. Ascension’s Agilify, which seeks to decrease time spent on tasks that can be automated, is an example of one such innovative approach.

7. Sharpening focus on revenue cycle: Many systems have identified opportunities in their revenue cycle processes, and there is heightened focus on collecting what is due for services rendered. A wide range of investor and provider owned companies have appeared in this space, from coding to collections, with very targeted approaches to improving overall effectiveness in the revenue cycle.

8. Consumerism takes hold: Engaging with consumers on a digital platform and meeting them where and when they want to be seen is a universal theme. Nearly every system presentation focused on the “consumer” rather than the patient and outlined an increased focus on digital strategy, leveraging the significant investments in EHRs over the last five years. A prime example is Adventist Health’s ‘hellowell’ digitally integrated application that allows patients to access their health records, schedule appointments, conduct virtual visits and message physicians. In addition, efforts to bring personalized medicine and big data analytics – such as the work underway at University of California Health System – will intensify the focus on creating long term relationships with consumers. Concerted effort is being made to measure and enhance overall consumer experience as the individual interfaces with multiple touchpoints throughout the system.

9. Diversifying revenue by growing services businesses: Health systems are developing professional services offerings to meet their own needs and those of other systems, whether in purchasing, revenue cycle, clinical asset management, specialty pharmacy, or personalized medicine. Companies like Mercy Health’s Ensemble and Ascension’s R1 are actively growing their client bases and competing with larger players in the RCM space. This may be a way to realize some of the benefits of scale without full system integration. Increasingly, health systems are incubating and monetizing innovations conceived by their employees or utilized by their companies.

10. Partnering is de rigueur: Partnering with specialty providers is no longer the purview of large systems like Northwell and Dignity Health, but rather a widely accepted strategy. Nearly all of the presenters featured a “partners page” highlighting the range of relationships they have developed and actively inviting further partnership in 2018. For example, Advocate reported that its partnership with Walgreens retail clinics, which launched in 2016, has introduced more than half of consumers in this setting to the health system. Keeping an eye on some of the complexities that develop from the consolidation of partners (e.g. Optum and SCA) will be a theme to watch in the coming years.

Not-for-Profit Track Statistics

Thank You!

The success of the J.P. Morgan Healthcare conference is a direct result of your participation, and we are honored that so many of you were able to join us this year. We strive to improve the conference each year, and appreciate any suggestions you may have to continue to enhance the experience.

Consecutive Years of a Dedicated NFP Track

NFP Track Presenters

NFP Health Systems in Attendance

NFP Track Participants

1x1 Meetings with NFP Investors

1x1 Meetings with

Healthcare Services

Companies

8 22 170+ 800+ 160+ 60+

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Additional Public Finance Team Members

Robert Servas, Managing Director Syndicate 212.834.7155 Frances Pak, Executive Director Credit Analysis Group 212.834.9191

Sarah Chessin, Executive Director Syndicate 212.834.7155 Meredith Mitchell, Vice President Credit Analysis Group 212.270.0648

Spencer Barton, Vice President Syndicate 212.834.7155 Annie Marinaro, Executive Director Debt Capital Markets 212.834.3261

Charlie Giffin, Managing Director Trading 212.834.7224 Dave Hand, Executive Director Derivatives Marketing 212.834.4686

Robert Muller, Managing Director Credit Strategy 212.834.7833 Sean Saroya, Executive Director Products 212.834.3430

This material is not a product of the Research Departments of J.P. Morgan Securities LLC ("JPMS") and is not a research report. Unless otherwise

specifically stated, any views or opinions expressed herein are solely those of the authors listed, and may differ from the views and opinions expressed by JPMS's

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This material was prepared exclusively for the benefit and internal use of the J.P. Morgan client to whom it is directly addressed and delivered (including such

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materials have been provided to the Client for informational purposes only and may not be relied upon by the Client in evaluating the merits of pursuing

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Information has been obtained from sources believed to be reliable but J.P. Morgan does not warrant its completeness or accuracy. Opinions and estimates

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J.P. Morgan's presentation is delivered to you for the purpose of being engaged as an underwriter, not as an advisor, (including, without limitation, a Municipal

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other interests that differ from yours.

This communication shall not constitute an offer to sell or the solicitation of an offer to buy, nor shall there be any sale of the securities in any state or jurisdiction

in which such an offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such state or jurisdiction.

This material does not carry any right of publication or disclosure, in whole or in part, to any other party, without the prior consent of J.P. Morgan. Additional

information is available upon request.

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Morgan Securities Ltd. (authorized by the FSA and member, LSE) and their investment banking affiliates.

Kimberly Allen, Managing Director 303.244.3379 Lisa Rogers, Executive Director 212.270.6356 Michael Schmidt, Associate 212.622.0450 Peter Reilly, Managing Director 415.315.7863 Adam Rudner, Executive Director 214.965.4420 Tiffany Bair, Analyst 212.270.2351 Steven Kim, Executive Director 415.315.5753 Jake Pancratz, Vice President 312.325.3210 Alex Freiberg, Analyst 212.270.0760 Charles Lee, Executive Director 212.270.0779 Dan Smith, Vice President 303.244.3386 Zachary Gilbert, Analyst 212.270.3124 Chris McCann, Executive Director 215.640.3454 David Gettemy, Associate 215.640.3556 Jason Kucza, Analyst 212.270.0117 Meghan O’Keefe, Executive Director 312.385.8453 Matthew Parmett, Associate 212.834.2098 Tyler Olkowski, Analyst 212.270.2781

J.P. Morgan’s Not-for-Profit Healthcare Investment Banking Team

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http://www.jpmm.com/

Presentation

UW HealthInvestment Policy Statement

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For Institutional Investor Use Only: Direct Client Presentation

Graystone Contracting & Documentation

Combined Portfolio Objectives & Risk Parameters

Current Portfolio Diagnostic & Holdings Analysis

Asset Consolidation & Transition Plan

Illiquid Assets Notification & Transfer Plan

Key Objectives

Quantify Desired Risk , Return and Liquidity Targets

Determine Allowable Asset Class Parameters

Asset Allocation Analysis & Monte Carl0

Select Final Asset Mix and Ranges

Implementation Kick-Off Meeting

Standing Monthly Committee Meetings

Quarterly Performance Review

Nov 2017 Dec 2017

Approve Manager Mapping Plan

Active/Passive Management Targets

Manager Search and Selection with Staff

Interviews of Final Recommended Candidates

Seek Approval for Final Manager Roster

Sept 2017 Oct 2017

Review and Compare Legacy Investment Policies

Draft & Discuss New Combined IPS Language

Present New IPS for Board Approval

Jan 2018

Program Design Meetings

Discovery & Contracting

Asset Allocation

Investment Policy

Manager Search & Selection

Sept 21st

Feb 2018 / Ongoing

Oct 11th Nov 29th Dec 13th

Manager Contracts & Documentation

Determine Transition Management Plan

Transition Assets to Graystone Consulting

Program Implementation

Transition Work Plan As of December 2017

In Progress

Complete

Complete

Complete

Complete

In Progress

Jan 23rd

Complete

Complete

Complete

Complete

Complete

Complete

Complete

In Progress

In Progress

In Progress

Complete

In Progress

Complete

In Progress

In Progress

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UW Mission and Vision

Trends in Social Responsible Investments and Sustainable Solutions

What is Impact Investing?

Opportunities for Greater Mission Alignment

Key Objectives

Determine Roles & Expectations: Staff versus Investment Committee

Best Practices for Committee Decision-making

Proposed Process Manager Selection & Changes

Discuss and Establish Committee Charter, Goals and Investment Philosophy

Document Routines for Governance & Operating

Establish Success Measures & Monitoring Criteria

Nov 2017 Dec 2017

Alternatives: Topical Education & Exploration on the Role of Alternative Investments in Institutional Programs

Active/Passive Management

Flexible Fixed Income Strategies

Sept 2017 Oct 2017

Historical Perspective on Investment Pools and Planned Consolidation

Overview on Health System Financial Considerations - Rating Agencies

Role of Investments and Days Cash on Hand

Jan 2018

Committee Charter

Sustainability & SRI

Decision Making

Operations & Finance

Investment Topics

Feb 2018 / Ongoing

Strategic Topics & Committee Education As of December 2017

Complete

Complete Complete

Complete

In Progress

In Progress

In Progress

Complete

Complete

Complete

Complete

In Progress

In Progress

Complete

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Investment Policy Statement

Effective as of January 25, 2018

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UW Health Table of Contents

Mission Statement Scope and Purpose………………………………..……………………………………………………………………….. 1 General Information General Investment Objectives..…….………………………………………………….……….…………………. 1 Definitions…………………………………………………………….……….………………..……………………………… 2 Assignment of Responsibility Finance Committee………...……………………………………………………….….…………………………………. 3 Investment Sub-Committee…..………………………..……………………….….…………………………………. 4 Management and Staff………………..……...………………………………….….…………………………………. 4 Investment Consultant……………………………………………………………….…………….………….………… 4 Investment Managers……………………………………………………………....….……………………..………… 5 The Investment Guidelines Specific Investment Goals……………………………………………….….………………………………….……… 5 Liquidity…………………………………………………………………………………………………….……..…………... 6 Investment Guidelines……………………………………………….….………….………………………………..… 7 Asset Allocation Guidelines…………………………………………………………………………………….…….. 10 Investment Manager Selection & Review Selection of Investment Managers……………………………………………………………………………..…. 10 Investment Manager Performance Review and Evaluation…………….……………..……………… 11 Conflicts of Interest………………………………………….………………………………………….………………… 13 Investment Policy Review…………………………………………………………..……………….………………… 13 Addendums…………………………………………………...………………….…………………………………………... 14

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ASSET ALLOCATION GUIDELINES

The Fund is expected to operate within an overall asset allocation strategy defining the portfolio’s mix of asset classes. This strategy, described below, sets a long-term percentage target for the Fund’s market value that is to be invested in any one asset class. The allocation strategy also defines the allowable investment shifts between the asset classes, above and below the target allocations. In line with the Fund’s return objectives and risk parameters, the mix of assets should be maintained as follows (percentages are of the market value of the Fund):

Asset Class Totals Minimum Target Maximum

Cash 0% 0% 10%

Fixed Income 35% 45% 55%

Global Equity 40% 50% 60%

Alternative Investments 0% 5% 10%

Please note, the asset allocation guidelines as specified above are to include the asset class exposures obtained through the UWF Endowment pooled fund.

Deviations from this asset mix guideline may be authorized by the Finance Committee, which may determine if the aggregate deviation constitutes a material departure from the spirit of the target allocation.

SELECTION OF INVESTMENT MANAGERS

The Investment Sub-Committee's selection of Investment Manager(s) must be based on prudent due diligence procedures. A qualifying Investment Manager must be a registered investment advisor under the Investment Advisors Act of 1940, or a bank or insurance company.

Investment Managers approved by the Investment Sub-Committee are chosen using criteria which may include, but is not limited to:

• Level of experience, financial resources and staffing levels of the Investment Manager;• The Investment Manager’s ability to provide an investment style or approach that

complements other Investment Managers in the portfolio;• Reasonableness of expense ratios / fees;• Past performance, considered relative to other investments having the same

investment objective. Consideration should be given to both consistency ofperformance and the level of risk taken to achieve results; and

• Stability of organization.

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UW Health

UW Health Addendum 1 to Investment Policy Statement

Investment Managers

The following Investment Managers have been retained by UW Health to manage a dedicated investment portfolio. The investment objectives and guidelines for the assets are defined in this document. The policy items included in the Investment Policy Statement are applicable for the entire Fund, but may not apply to each individual Investment Manager.

Specific Investment Goals Over the investment horizon established in the Investment Policy Statement, it is the goal of the assets managed by each investment management firm to meet or exceed:

Manager Benchmark BlackRock Short Duration BofA Merrill Lynch 1-3 Year Treasury US Bank Asset Management BofA Merrill Lynch 1-3 Year Treasury Baird Advisors Intermediate Bond Bloomberg Barclays Intermediate Govt / Credit JPMorgan Asset Management Core Bond Bloomberg Barclays US Aggregate Bond Western Asset Core Plus Portfolio Bloomberg Barclays US Aggregate Bond BlackRock Strategic Income Opportunities Fund Bloomberg Barclays US Universal Vanguard Value Index ETF CRSP US Large Cap Value Aristotle Capital Management Value Equity Russell 1000 Value Delaware Investments Large Cap Value Equity Russell 1000 Value Vanguard Growth Index ETF CRSP US Large Cap Growth Alliance Bernstein Concentrated US Growth Russell 1000 Growth ClearBridge Large Cap Growth ESG Russell 1000 Growth TSW Mid Cap Value Russell Midcap Value Congress Asset Management Mid Cap Growth Russell Midcap Growth Delaware Investments Small Cap Value Equity Russell 2000 Value Henderson Geneva US Small Cap Growth Russell 2000 Growth Vanguard FTSE Developed Markets ETF FTSE Developed All Cap ex-US Cambiar Investors International Equity MSCI ACWI ex-US Invesco International Growth MSCI ACWI ex-US Lazard Asset Mgmt Emerging Mkts Equity Select MSCI Emerging Markets VanEck Emerging Markets Fund MSCI Emerging Markets University of Wisconsin Foundation Blend of MSCI ACWI, Burgiss Private iQ Custom,

NCREIF NFI-ODCE and Bloomberg Barclays Global Aggregate Bond

Volatility (Risk) Each investment strategy is expected to meet its objectives with a level of risk which is

consistent with the risk associated with the index stated above.

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UW HEALTH INVESTMENT SUB-COMMITTEE CHARTER

Introduction The University of Wisconsin Hospitals and Clinics Authority (“UWHCA”) Investment Sub-Committee (the “Investment Sub-Committee”) is a standing Sub-Committee of the Finance Committee of the UWHCA Board of Directors (the “Finance Committee”). The Investment Sub-Committee reports to the UWHCA Finance Committee.

Purpose The purpose of the Investment Sub-Committee is to establish, implement, maintain, and oversee an ongoing investment program for the Fund (as hereinafter defined) consistent with the Investment Policy Statement (as hereinafter defined), in a manner which protects the financial position of UW Health (as defined herein) while supporting UW Health’s mission. As used herein, “UW Health” refers to UWHCA, University of Wisconsin Medical Foundation (“UWMF”), Swedish American Health System Corporation and their wholly-owned subsidiaries, SwedishAmerican Hospital (SAH) and SwedishAmerican Foundation (SAF; and “Fund” means the single pool of investment assets of UWHCA, UWMF, the Swedish American Hospital Operating Fund (“SAH Operating”) and the Swedish American Foundation (“SAF ”) as contributed to the Fund from time to time by each of UWHCA, UWMF, SAH Operating, and SAF (each an “Investor”) from time to time under that certain Investment Pooling Agreement entered into among such parties and effective as of January 25, 2018, as the same may be amended from time to time (the “Pooling Agreement”).

Membership The Investment Sub-Committee shall be comprised of seven (7) members, named as follows:

• Three (3) individuals nominated by UWHCA;• Two (2) individuals nominated by UWMF; and• Two (2) individuals nominated by SAHS.

The Finance Committee shall approve each member nominated to the Investment Sub-Committee, and upon such approval each nominee shall become a member of the Investment Subcommittee and shall serve in such role until his or her earlier resignation or removal. Vacancies in Investment Sub-Committee membership may be filled by Investor with the right to nominate such Member (subject to Finance Committee approval). Any Investor may remove a member of the subcommittee designated by that Member at any time.

The Investment Sub-Committee’s Chair (the “Chair”) shall be a member of the Investment Subcommittee and shall be approved by the members of the Investment Sub-Committee, by majority vote.

Meetings The Chair or his/her delegate shall preside at meetings of the Investment Sub-Committee and shall set the agenda. The Investment Sub-Committee shall meet at least quarterly and

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Key Metrics • Long Term Investments as of August 2017 $1.56 B

• Current Long-Term Investments $1.25 B

• Current 1 Day Cash on Hand $7.7 M

• Current UW Health Cash on Hand Reserves 203.3 days

• Moody’s Aa3 Median 267 days

• S&P AA- Median 258 days

Current Consolidated

Portfolio Sample 45/55

Portfolio Mix 1 Sample 55/45

Portfolio Mix 2 Sample 65/35

Portfolio Mix 3 Private Equity Only

Portfolio Mix 4 Hedge Funds Only

Portfolio Mix 5

Liquid Alts Hedge Funds & RE

Portfolio Mix 6 Healthcare Peer Group Average

Expected Return 5.90% 6.50% 7.00% 7.60% 8.00% 7.30% 7.60% 7.00%

Forecasted Volatility 6.30% 7.60% 8.90% 10.30% 10.70% 9.50% 9.80% 8.30%

1-year Expected Tail Loss (ETL) $94.0 million $120.9 million $148.3 million $175.7 million $192.1 million $161.5 million $167.4 million $136.0 million

Days Cash on Hand at Risk 12.21 days 15.70 days 19.26 days 22.82 days 24.95 days 20.98 days 21.75 days 17.66 days

Impact on AA- credit rating 191.09 days 187.60 days 184.04 days 180.48 days 178.35 days 182.32 days 181.55 days 185.64 days

Year 1: Value at Risk – Impact on Days Cash on Hand

Days Cash on Hand represents the number of days of operating expenses that an organization could pay with its current cash available. The cash available includes operating cash and investments that can easily converted to cash. Measures liquidity and strength of an organization.

1-yr Expected Tail Loss (ETL) and Value at Risk (VAR) A risk assessment measure that quantifies the possible magnitude of extreme net losses that different portfolio allocations could generate within a one-year period. It calculates the likelihood that a specificloss will exceed beyond a 2 standard deviation event. ETL is often the risk measure used as the basis for risk budgeting.

Days Cash on Hand at Risk (DCOH) Days Cash on Hand is an important measure of hospital liquidity. An organization needs a certain amount to meet the requirement of lenders, rating agencies and others. There are no magic numbers and your cash levels depend largely on your strategies, your market, and your opportunities. All organizations have different levels of risk tolerance and the DCOH is a function of the financial leadership’s comfort level, e.g. the ideal level is what makes it possible for them to sleep soundly at night. Days Cash on Hand at Risk is calculated by dividing the 1-year ETL divided by the Current 1 Day Cash on Hand. It measures the negative impact of a Fat Tail event on the number of Days Cash on Hand.

Impact on AA- Credit Rating This metric is calculated by taking the current Days Cash on Hand and subtracting the Days Cash on Hand at Risk. It indicates the shortfall relative to the benchmark established by the rating agencies for AA-Rated NFP Health Systems.

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% of Portfolio Assets

Short Term Fixed Income 11.50% $142,937,239.01

US Fixed Income 29.50% $366,602,356.34

Fixed Income – UW Foundation 3.37% $41,818,021.88

Cash – UW Foundation 0.21% $2,641,138.22

Total Fixed Income 44.58% $553,998,755.45

Large Cap Passive Index Fund 11.62% $144,466,182.80

US Large Cap 3.88% $48,155,394.27

US Mid Cap 3.00% $37,281,595.56

US Small Cap 3.00% $37,281,595.56

International Developed Passive Index 3.95% $49,087,434.15

International Developed 10.56% $131,231,216.37

Emerging Markets 5.30% $65,864,152.16

Global Equities – UW Foundation 10.63% $132,056,911.20

Total Global Equity 51.94% $645,424,482.06

Alternatives – UW Foundation 3.51% $43,578,780.70

Total Alternative Investments 3.51% $43,578,780.70

Total 100.00% $1,243,002,018.21

Portfolio Mix 2: 55/45

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Recommended Asset Allocation Mix UW Health

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Selected Managers UW Health

US Equity International Equity

Vanguard Growth Index

AllianceBernstein Concentrated US Growth

Clearbridge Large-Cap Growth ESG

Vanguard Value Index

Aristotle Capital Management Value Equity

Delaware Investments Large Cap Value

Congress Asset Mgmt Mid-Cap Growth

TSW Mid-Cap Value

Delaware Investments Small Value

Henderson Geneva US Small Growth

Vanguard FTSE Developed World

Invesco Intl. Growth

Cambiar International Equity

Lazard Emerging Markets Select

Van Eck Emerging Markets

Fixed Income

Blackrock Short Duration

Baird Advisors Intermediate Bond

JP Morgan Core Bond

Western Core Asset Plus

Blackrock Strategic Income Opportunities

US Bank Short Duration

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Attachment


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Effective as of January 25, 2018

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UW Health Table of Contents

Mission Statement Scope and Purpose………………………………..……………………………………………………………………….. 1 General Information General Investment Objectives..…….………………………………………………….……….…………………. 1 Definitions…………………………………………………………….……….………………..……………………………… 2 Assignment of Responsibility Finance Committee………...……………………………………………………….….…………………………………. 3 Investment Sub-Committee…..………………………..……………………….….…………………………………. 4 Management and Staff………………..……...………………………………….….…………………………………. 4 Investment Consultant……………………………………………………………….…………….………….………… 4 Investment Managers……………………………………………………………....….……………………..………… 5 The Investment Guidelines Specific Investment Goals……………………………………………….….………………………………….……… 5 Liquidity…………………………………………………………………………………………………….……..…………... 6 Investment Guidelines……………………………………………….….………….………………………………..… 7 Asset Allocation Guidelines…………………………………………………………………………………….…….. 10 Investment Manager Selection & Review Selection of Investment Managers……………………………………………………………………………..…. 10 Investment Manager Performance Review and Evaluation…………….……………..……………… 11 Conflicts of Interest………………………………………….………………………………………….………………… 13 Investment Policy Review…………………………………………………………..……………….………………… 13 Addendums…………………………………………………...………………….…………………………………………... 14

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UW Health

SCOPE OF THIS INVESTMENT POLICY STATEMENT This Investment Policy Statement (“IPS”) sets forth the investment policy, objectives, guidelines for and constraints of investment of the Fund (as hereinafter defined). The Finance Committee, and Board of Directors (the “Board”) of the University of Wisconsin Hospitals and Clinics Authority (“UWHCA”) have approved this IPS. PURPOSE OF THIS INVESTMENT POLICY STATEMENT This Investment Policy Statement is intended to provide guidance to the Finance Committee, Investment Sub-Committee, Investment Consultant and the Investment Managers responsible for managing the Fund’s assets and outlines certain specific investment policies, which will govern how to achieve those goals and objectives. It is intended to:

1. Define and assign the responsibilities of the parties involved in the management and oversight of the Fund.

2. Establish a clear understanding of the investment goals and objectives, as well as risk tolerance as the basis for evaluating investment results.

3. Establish asset allocation guidelines that reflect UW Health’s risk posture.

4. Offer guidelines regarding the selection of investment manager(s) who will provide a consistent level of superior risk-adjusted performance at the total program level over full market cycles.

The investment guidelines described in the IPS are dynamic and reflect the Fund’s financial needs and circumstances, the time horizon available for investment, and the philosophy regarding the investment of assets. The IPS will be reviewed annually by the Investment Sub-Committee with revisions recommended to the Finance Committee for further approval. GENERAL INVESTMENT OBJECTIVES In general, the primary investment objective is to sustain and grow the long-term financial assets of the Fund, while incorporating the mission and values of UW Health, avoiding excessive risk, maintaining sufficient liquidity to meet potential cash flow requirements and

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meeting financial obligations as they are due. To accomplish this, the investment pool is expected to earn returns in excess of a passive set of market indexes representative of the underlying strategic asset allocation targets. The Finance Committee and Investment Sub-Committee believe that the achievement of investment returns should be viewed in a long-term context. The Finance Committee and Investment Sub-Committee recognize that rates of return are volatile on a year-to-year basis and that investment returns will not progress uniformly over time. Thus, volatility will be tolerated in as much as it is consistent with the volatility of a comparable market index. Use of a diversified array of investments with active and passive strategies that will benefit the portfolio as a whole throughout varying market environments, in so far as it may enhance returns objectives and reduce portfolio risk, is desired. DEFINITIONS

1. “Fund” shall mean the single integrated investment pool of the assets of each UWHCA, UWMF, SAH Operating, and SAF, contributed thereto by each of the Investors from time to time pursuant to that certain Investment Pooling Agreement to be entered into among the Investors, as the same may be amended from time to time (the “Pooling Agreement”).

2. “Finance Committee” is the Finance Committee of the UWHCA Board of Directors.

3. “Investment Sub-Committee” shall refer to the sub-committee of the Finance Committee that was established to direct the administration and investment management of Fund assets in accordance with the Investment Sub-Committee Charter and this IPS.

4. “Investment Manager” shall mean any individual, group of individuals, or entity employed to manage the investments of part of the Fund assets.

5. “Investment Consultant” shall mean any individual, group of individuals or entity employed to provide advisory services, including advice on investment objectives and/or asset allocation, investment manager search, and performance monitoring.

6. “Investor” means each of UWHCA, the University of Wisconsin Medical Foundation (“UWMF”), the SwedishAmerican Hospital Operating Fund (“SAH Operating”), and the SwedishAmerican Foundation (“SAF”).

7. “Custodian” shall refer to the firm responsible for all duties relating to the physical possession of securities owned by the Fund, including the collection of dividend and interest payments, the redemption of maturing securities, and effecting the receipt and

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delivery of assets following purchases and sales.

8. “Securities” shall refer to the marketable investment securities which are defined as acceptable in this IPS.

9. “Investment Horizon” shall be the time period over which the investment objectives, as set forth in this IPS, are expected to be met. While the investment horizon for this Fund is long-term in nature, investment performance expectations as detailed in this IPS will be evaluated over a full market cycle (typically 5 – 7 years).

ASSIGNMENT OF RESPONSIBILITIES Responsibility of the Finance Committee of UW Health

Except to the extent otherwise stated herein, by virtue of the approval of this IPS by the UWHCA Board, the Finance Committee has been delegated the authority to act on behalf of the Board to oversee the management of Fund assets and, in carrying out its responsibilities hereunder, shall have all of the powers and authority of the Board. The Finance Committee shall discharge its duties solely in the interest of the Fund, with the care, skill, prudence, and diligence under the circumstances then prevailing, that a prudent person, acting in a like capacity and familiar with such matters, would use in the conduct of an enterprise of a like character with like aims. The Finance Committee has the responsibility to:

1. Administer the IPS;

2. Approve risk objectives as recommended by the Investment Sub-Committee;

3. Approve changes to overall asset allocation structure and positioning (outside of tactical asset allocation shifts and routine rebalancing efforts);

4. In coordination with the Investment Sub-Committee, prudently and diligently select and/or replace investment professionals, including Investment Managers, Investment Consultant(s), Custodian(s), and any other service providers that it deems necessary;

5. On a periodic basis, review the performance of the Fund, Investment Managers, and Investment Consultants in coordination with the Investment Sub-Committee and/or an Investment Consultant; and

6. Such other responsibilities regarding the Fund as may be delegated to the Finance Committee from time to time by the UWHCA Board of Directors.

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Responsibility of the Investment Sub-Committee of UW Health

The Investment Sub-Committee was established as a sub-committee of the Finance Committee to direct the administration and investment management of Fund assets. The Investment Sub-Committee shall have the responsibilities set forth from time to time in the UW Health Investment Sub-Committee Charter, the current version of which is attached hereto as Addendum 2. Responsibility of Management and Staff of UW Health

Management and Staff of UW Health are responsible for implementing the IPS subject to the oversight of both the Finance Committee and Investment Sub-Committee. Management and Staff have the responsibility to:

1. Project the Fund’s financial needs and communicate such needs to the Investment Consultant on a timely basis;

2. Recommend to the Investment Sub-Committee the selection of Investment Managers;

3. Rebalance the Fund allocations on a periodic basis in coordination with the Investment Consultant; and

4. Review, at least annually, the IPS and specific Investment Manager guidelines. Responsibility of the Investment Consultant

The Investment Consultant's role is that of a non-discretionary advisor to the Finance Committee and Investment Committee of UW Health. Investment advice concerning the investment management of Fund assets will be offered by the Investment Consultant, and will be consistent with the investment objectives, policies, guidelines and constraints as established in this IPS. Contracts for services with any Investment Consultant shall provide that the responsibilities of the Investment Consultant will include:

1. Assisting in the development and periodic review of Investment Policy, asset allocation strategy and portfolio structure;

2. Assisting Management / Staff and the Investment Sub-Committee in the selection of investment manager(s) and strategies;

3. Support management in the oversight, due diligence and review of Investment Managers;

4. Provide written performance measurement reports on a quarterly basis;

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5. Responsibility for the day-to-day monitoring of Investment Managers to ensure they

are in compliance with the Fund’s goals, objectives and the IPS;

6. Meet with the Investment Sub-Committee and Management / Staff quarterly, or as necessary, to review investment performance and consider whether any changes or other actions are necessary with respect to the investment portfolio; and

7. Such other responsibilities as are set forth in the contract with the Investment Consultant.

Responsibility of the Investment Manager(s)

Each Investment Manager will have discretion to make all investment decisions for the assets placed under its jurisdiction, while observing and operating within all policies, guidelines, constraints, and philosophies as outlined in this IPS. In recognition of the benefits of diversification, it is the intention of the Fund to use mutual funds, exchange traded funds, or commingled vehicles in addition to the utilization of separately managed accounts. Notwithstanding the foregoing, the Finance Committee, Investment Sub-Committee and Investment Consultant understand that the guidelines outlined in this IPS will not be directly applied to the management of such commingled vehicles. Contracts for services with any Investment Manager(s) shall provide that the responsibilities of the Manager(s) will include:

1. Discretionary investment management including decisions to buy, sell, or hold individual securities, and to alter asset allocation within the guidelines established in this IPS; and

2. Requirements that each Investment Manager will: a. Promptly communicate any material changes in the Investment Manager’s

outlook, investment strategy, investment policy, and tactics;

b. Be available on a reasonable basis for telephone communication when needed; and

c. The Investment Manager will discuss any significant changes in ownership

structure, changes in key investment personnel and/or management, and investment practices.

Absent delegation to another service provider, each Investment Manager is responsible and empowered to exercise all rights, including proxy voting rights, as are acquired through the purchase of securities, where practical.

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SPECIFIC INVESTMENT GOALS Return Objectives It is expected that over a full market cycle (typically lasting 5-7 years) the total return on the UW Health investment portfolio will outpace the Policy Index return measured on a compound annual return basis after the deduction of investment management fees. The Policy Index shall be represented by a composite market index comprised of passive market indices combined in the same percentage as the Fund’s strategic asset allocation targets. The investment goal above is the objective of the aggregate Fund and is not meant to be imposed on each investment account individually. The Policy Index is currently constructed as follows:

Policy Index Composition Fixed Income Bloomberg Barclays US Aggregate Bond Index 50% Global Equity MSCI ACWI 50% Risk Objectives The risk objective for the aggregate Fund is the target standard deviation chosen from asset allocation modeling as measured by volatility (standard deviation), and is similar to the volatility level of the Policy Index when measured over a full market cycle. The Fund’s risk level balances portfolio stability and portfolio appreciation and includes a moderate level of volatility and risk of principal loss. The portfolio will include a balance of fixed income, equities and alternative investments. Thus, volatility will be tolerated in as much as it is consistent with the volatility of a comparable market index. Understanding that risk is present in all types of securities and investment styles, the Finance Committee and Investment Sub-Committee recognize that some risk is necessary to produce long-term investment results that are sufficient to meet the Fund’s investment objectives. However, unnecessary levels of risk-taking are to be avoided, as the Finance Committee and Investment Sub-Committee recognize that it may be necessary to forego opportunity for potential large gains to achieve a reasonable risk posture. LIQUIDITY To minimize the possibility of a loss occasioned by the sale of a security forced by the need to meet a required payment, the Investment Sub-Committee, in coordination with Management and Staff, will periodically provide the Investment Consultant with an estimate of expected net cash flow. The Investment Sub-Committee / Management and Staff will notify the Investment Consultant in a timely manner, to allow sufficient time to build up necessary liquid reserves.

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INVESTMENT GUIDELINES Allowable Assets

1. Cash Equivalents • Treasury Bills • Money Market Funds • Commercial Paper • Banker's Acceptances • Repurchase Agreements • Certificates of Deposit

2. Fixed Income Securities

• U.S. Government and Agency Securities • Corporate Notes and Bonds • Mortgage Backed Bonds • Preferred Stock • Asset Backed Securities • Municipal Securities • Fixed Income Securities of Foreign Governments & Corporations (Dollar-

Denominated Only) • Non-Investment Grade (High-Yield) Bonds

3. Equity Securities

• Common Stocks • Convertible Notes and Bonds • Convertible Preferred Stocks • American Depository Receipts (ADRs) of Non-U.S. Companies • Stocks of Non-U.S. Companies (Ordinary Shares) • Real Estate Investment Trusts (REITs)

4. Mutual Funds / Exchange Traded Funds

• Mutual Funds / Exchange Traded Funds which invest in securities as allowed in this statement

5. Alternative Investments

• Hedge Funds • Private Equity / Private Real Estate • Limited Partnerships • Master Limited Partnerships • Real Assets / Real Estate

6. University of Wisconsin Foundation (UWF) Endowment pooled funds

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Stock Exchanges To ensure marketability and liquidity, equity transactions will be executed using primarily the following exchanges: New York Stock Exchange, American Stock Exchange, and NASDAQ. Other exchanges and methods may be used in an effort to achieve the best possible execution. Prohibited Assets* Prohibited individual investments are any investments that are not specifically authorized within this statement (except for assets held in a UWF Endowment pooled fund, mutual fund or exchange traded fund as described under Allowable Assets). Those include, but are not limited to, the following:

1. Commodities and Futures Contracts 2. Private Placements 3. Lettered or Restricted Stock 4. Limited Partnerships 5. Venture Capital 6. Tangible Personal Property 7. Direct Real Estate 8. Art / Precious Metals 9. Short Selling 10. Margin Transactions 11. Oil and Gas Payments / Drilling Partnerships

* With the exception of Finance Committee approved dedicated portfolios of Alternative Investments. Prohibited Transactions* Prohibited transactions include, but are not limited to the following:

1. Short Selling 2. Margin Transactions

*With the exception of Finance Committee approved dedicated portfolios of Alternative Investments. Diversification Requirements The primary method to reduce risk for the Fund is diversification through asset allocation. By allocating assets in different asset classes, the portfolio can reduce risk by avoiding concentration as well as reduce risk through the low correlation between different asset classes. Each Investment Manager has discretion with regard to security selection and allocation within its respective portfolio. Unless otherwise noted, under normal market conditions, each Investment Manager is expected to be invested consistent with its investment style as described in its relevant documentation.

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To minimize the risk of large losses, each Investment Manager shall maintain adequate diversification in their portfolio subject to the constraints outlined in the IPS. Alternative Investments Alternative investments represent investments in vehicles that seek to provide diversification through innovative and flexible strategies (such as the ability to short, add leverage and hedge). Investments in such vehicles are expected to provide diversification and the opportunity for capital appreciation. Diversification standards within each investment vehicle shall be according to the prospectus or trust document. Investments in these vehicles carry special risks. The Fund may (with specific Finance Committee approval) utilize speculative investment strategies, trade in volatile securities, and use leverage in an attempt to generate superior investment returns. The Fund may invest in illiquid securities for which there is no ready market and place restrictions on investors as to when funds may be withdrawn. The organization acknowledges that: (1) Alternative investments can be highly illiquid and may engage in leveraging and other speculative investment practices, which may involve volatility of returns and significant risk of loss, including the potential for loss of the principal invested; (2) That there is no secondary market currently available for interests in most alternative investments and that there may be restrictions imposed by the fund on transferring such interests as stated in the fund’s private placement memorandum or prospectus; (3) That investing in alternative investments is only suitable for experienced and sophisticated investors who are willing to bear the high economic risks of the investment and that this Fund qualifies as such an investor; (4) That it will carefully review and consider all potential risks before investing including the following specific risks:

• loss of all or a substantial portion of the investment due to leveraging, short-selling, or other speculative practices;

• lack of liquidity in that there may be no secondary market for the fund and none is expected to develop;

• volatility of returns; • restrictions on transferring interests in the Fund; • potential lack of diversification and resulting higher risk due to concentration of trading

authority when a single advisor is utilized; • absence of information regarding valuations and pricing; • complex tax structures and delays in tax reporting; • less regulation and higher fees than mutual funds; and • firm-specific investment manager risk.

Securities Lending Securities lending is not permitted under this IPS except for that which may be done by a mutual fund or in the University of Wisconsin Foundation Endowment Fund.

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ASSET ALLOCATION GUIDELINES The Fund is expected to operate within an overall asset allocation strategy defining the portfolio’s mix of asset classes. This strategy, described below, sets a long-term percentage target for the Fund’s market value that is to be invested in any one asset class. The allocation strategy also defines the allowable investment shifts between the asset classes, above and below the target allocations. In line with the Fund’s return objectives and risk parameters, the mix of assets should be maintained as follows (percentages are of the market value of the Fund):

Asset Class Totals Minimum Target Maximum

Cash 0% 0% 10%

Fixed Income 35% 45% 55%

Global Equity 40% 50% 60%

Alternative Investments 0% 5% 10%

Please note, the asset allocation guidelines as specified above are to include the asset class exposures obtained through the UWF Endowment pooled fund. Deviations from this asset mix guideline may be authorized by the Finance Committee, which may determine if the aggregate deviation constitutes a material departure from the spirit of the target allocation.

SELECTION OF INVESTMENT MANAGERS The Investment Sub-Committee's selection of Investment Manager(s) must be based on prudent due diligence procedures. A qualifying Investment Manager must be a registered investment advisor under the Investment Advisors Act of 1940, or a bank or insurance company. Investment Managers approved by the Investment Sub-Committee are chosen using criteria which may include, but is not limited to:

• Level of experience, financial resources and staffing levels of the Investment Manager; • The Investment Manager’s ability to provide an investment style or approach that

complements other Investment Managers in the portfolio; • Reasonableness of expense ratios / fees; • Past performance, considered relative to other investments having the same

investment objective. Consideration should be given to both consistency of performance and the level of risk taken to achieve results; and

• Stability of organization.

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University of Wisconsin Foundation (UWF) UWF manages pooled investment funds on behalf of multiple University of Wisconsin affiliated entities. Historically, UWHCA has invested with UWF in an Endowment Fund pooled vehicle. The UWF Endowment portfolio is an internationally diversified pooled fund. Asset selection is at the full discretion of UWF. As such, the Investor has no involvement in the manager and selection of invested assets. The asset allocation consists of domestic, international, and private equities, hedge funds, fixed income and real assets (certain of which would otherwise be prohibited under this policy). As such, it serves as a vehicle to diversify a portfolio to include limited exposure to more aggressive, higher yielding investment categories. It is the intention of the Board and Finance Committee to permit a limited amount of exposure to the Endowment Fund for purposes of diversification, return and risk management. INVESTMENT MANAGER PERFORMANCE REVIEW AND EVALUATION Performance reports generated by the Investment Consultant shall be compiled at least quarterly and communicated to the Investment Sub-Committee for review. The investment performance of total portfolios, as well as asset class components, will be measured against commonly accepted performance benchmarks. Consideration shall be given to the extent to which the investment results are consistent with the investment objectives, goals, and guidelines as set forth in this statement. The Finance Committee and Investment Sub-Committee intend to evaluate the portfolio(s) over longer-term periods, but reserve the right to terminate an Investment Manager for any reason including the following:

1. Investment performance which is significantly less than anticipated given the discipline employed and the risk parameters established, or unacceptable justification of poor results.

2. Failure to adhere to any aspect of this statement of investment policy, including communication and reporting requirements.

3. Significant qualitative changes to the investment management organization.

4. Significant style drifts from stated discipline.

Investment Managers shall be reviewed regularly regarding performance, personnel, strategy, research capabilities, organizational and business matters, and other qualitative factors that may impact their ability to achieve the desired investment results. The Investment Sub-Committee intends to evaluate the actively-managed traditional investment strategies based upon the following criteria over a full market cycle:

1. Benchmark Correlation

• Three-, five-, and seven-year R2 should be greater than or equal to 0.80

2. Annualized Performance

• Three-, five-, and seven-year annualized return should surpass benchmark

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3. Risk-Adjusted Performance

• Three-, five-, and seven-year Sharpe Ratio (excess return divided by standard deviation of returns) should be above benchmark

4. Down Market Performance

• Three-, five-, and seven-year down capture ratio should be less than 1.0

5. Peer Universe

• Percentile ranking of portfolio’s three-, five-, and seven-year annualized return against peer group should be above median (50%)

6. Investment Management Organization Changes

• Turnover of portfolio manager or other personnel significant to the firm’s management process

• Ownership change • Involvement in relevant regulatory investigation or litigation • Significant increase in fees

7. Deviation from Investment Methods basic to Historical Records

• Aggregate assets in product are insufficient to ensure broad diversification, efficient trading, and economies of scale

• Assets in product grow too large to continue to be managed in a manner similar to methods that built historical performance

• Portfolio characteristics do not match stylistic expectations In the event that an Investment Manager is under watch by the Investment Sub-Committee or circumstances have arisen that require an immediate review, the Investment Sub-Committee will evaluate the Investment Manager in question and determine what, if any, action should be taken. Generally, the Investment Sub-Committee may make one of three decisions:

♦ Satisfied with Explanation – The Investment Sub-Committee is satisfied with the results of the Investment Manager review and will continue with the normal quarterly investment reviews.

♦ Place Manager on Watch List – The Investment Sub-Committee is concerned with the Investment Manager’s ability to meet the performance objectives and accordingly, the Investment Manager is put on watch and will be subject to a more detailed review at each quarterly performance review. The Investment Sub-Committee will then reevaluate the manager’s overall investment performance to make a determination as to whether to continue with the manager, terminate the manager or continue it on watch.

♦ Review Alternatives and Replace Manager – Review alternatives and replace the manager as an investment component of the Fund.

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CONFLICTS OF INTEREST All investment decisions and actions performed on behalf of the Fund by any of the selected investment professionals shall be performed solely for the benefit and best interests of the Investors. If any investment professional has a conflict of interest that might impair its ability to carry out decisions and actions in the best interest of the Investors, it must be disclosed in writing to the Finance Committee and Investment Sub-Committee. INVESTMENT POLICY REVIEW To assure continued relevance of the guidelines, objectives, financial status and capital markets expectations as established in this Statement of Investment Policy, the Investment Sub-Committee plans to review investment policy at least annually. This Investment Policy Statement is adopted on January 25, 2018 by the UWHCA Board of Directors. __________________________________ __________________________________ Name: Name: Title: Title: __________________________________ __________________________________ Name: Name: Title: Title: __________________________________ __________________________________ Name: Name: Title: Title:

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UW Health

Addendum 1 to Investment Policy Statement Investment Managers

The following Investment Managers have been retained by UW Health to manage a dedicated investment portfolio. The investment objectives and guidelines for the assets are defined in this document. The policy items included in the Investment Policy Statement are applicable for the entire Fund, but may not apply to each individual Investment Manager. Specific Investment Goals Over the investment horizon established in the Investment Policy Statement, it is the goal of the assets managed by each investment management firm to meet or exceed: Manager Benchmark BlackRock Short Duration BofA Merrill Lynch 1-3 Year Treasury US Bank Asset Management BofA Merrill Lynch 1-3 Year Treasury Baird Advisors Intermediate Bond Bloomberg Barclays Intermediate Govt / Credit JPMorgan Asset Management Core Bond Bloomberg Barclays US Aggregate Bond Western Asset Core Plus Portfolio Bloomberg Barclays US Aggregate Bond BlackRock Strategic Income Opportunities Fund Bloomberg Barclays US Universal Vanguard Value Index ETF CRSP US Large Cap Value Aristotle Capital Management Value Equity Russell 1000 Value Delaware Investments Large Cap Value Equity Russell 1000 Value Vanguard Growth Index ETF CRSP US Large Cap Growth Alliance Bernstein Concentrated US Growth Russell 1000 Growth ClearBridge Large Cap Growth ESG Russell 1000 Growth TSW Mid Cap Value Russell Midcap Value Congress Asset Management Mid Cap Growth Russell Midcap Growth Delaware Investments Small Cap Value Equity Russell 2000 Value Henderson Geneva US Small Cap Growth Russell 2000 Growth Vanguard FTSE Developed Markets ETF FTSE Developed All Cap ex-US Cambiar Investors International Equity MSCI ACWI ex-US Invesco International Growth MSCI ACWI ex-US Lazard Asset Mgmt Emerging Mkts Equity Select MSCI Emerging Markets VanEck Emerging Markets Fund MSCI Emerging Markets University of Wisconsin Foundation Blend of MSCI ACWI, Burgiss Private iQ Custom,

NCREIF NFI-ODCE and Bloomberg Barclays Global Aggregate Bond

Volatility (Risk)

Each investment strategy is expected to meet its objectives with a level of risk which is consistent with the risk associated with the index stated above.

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UW Health Addendum 2 to Investment Policy Statement

UW Health Investment Sub-Committee Charter

SEE ATTACHED.

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UW HEALTH INVESTMENT SUB-COMMITTEE CHARTER

Introduction The University of Wisconsin Hospitals and Clinics Authority (“UWHCA”) Investment Sub-Committee (the “Investment Sub-Committee”) is a standing Sub-Committee of the Finance Committee of the UWHCA Board of Directors (the “Finance Committee”). The Investment Sub-Committee reports to the UWHCA Finance Committee. Purpose The purpose of the Investment Sub-Committee is to establish, implement, maintain, and oversee an ongoing investment program for the Fund (as hereinafter defined) consistent with the Investment Policy Statement (as hereinafter defined), in a manner which protects the financial position of UW Health (as defined herein) while supporting UW Health’s mission. As used herein, “UW Health” refers to UWHCA, University of Wisconsin Medical Foundation (“UWMF”), Swedish American Health System Corporation and their wholly-owned subsidiaries, SwedishAmerican Hospital (SAH) and SwedishAmerican Foundation (SAF; and “Fund” means the single pool of investment assets of UWHCA, UWMF, the Swedish American Hospital Operating Fund (“SAH Operating”) and the Swedish American Foundation (“SAF ”) as contributed to the Fund from time to time by each of UWHCA, UWMF, SAH Operating, and SAF (each an “Investor”) from time to time under that certain Investment Pooling Agreement entered into among such parties and effective as of January 25, 2018, as the same may be amended from time to time (the “Pooling Agreement”). Membership The Investment Sub-Committee shall be comprised of seven (7) members, named as follows:

• Three (3) individuals nominated by UWHCA; • Two (2) individuals nominated by UWMF; and • Two (2) individuals nominated by SAHS.

The Finance Committee shall approve each member nominated to the Investment Sub-Committee, and upon such approval each nominee shall become a member of the Investment Subcommittee and shall serve in such role until his or her earlier resignation or removal. Vacancies in Investment Sub-Committee membership may be filled by Investor with the right to nominate such Member (subject to Finance Committee approval). Any Investor may remove a member of the subcommittee designated by that Member at any time.

The Investment Sub-Committee’s Chair (the “Chair”) shall be a member of the Investment Subcommittee and shall be approved by the members of the Investment Sub-Committee, by majority vote.

Meetings The Chair or his/her delegate shall preside at meetings of the Investment Sub-Committee and shall set the agenda. The Investment Sub-Committee shall meet at least quarterly and

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otherwise as often as deemed necessary or appropriate, in its judgment, to discharge its duties and responsibilities. Meetings of the Investment Sub-Committee may be held in-person and/or via telephonic or electronic or video conference, and at such times and places as the Investment Sub-Committee determines. A majority of the then-sitting members of the Investment Sub-Committee shall constitute a quorum for the transaction of business at any meeting of the Investment Sub-Committee. Manner of Acting Each member of the Investment Sub-Committee shall have one (1) vote on all matters bought before the Investment Sub-Committee within the scope of its authority. The act of a majority of the members of the Investment Sub-Committee at a meeting at which a quorum is present shall be the act of the Investment Sub-Committee. Duties and Responsibilities of the Investment Sub-Committee In addition to carrying out any other responsibilities delegated to the Investment Sub-Committee by the Finance Committee from time to time, the Investment Sub-Committee shall:

Investment Policy Statement, Portfolio Risk and Key Reserve Attributes • Develop, maintain, and review and revise from time to time, as appropriate, in each

case subject to the Finance Committee approval, an investment policy for UW Health outlining the objectives and guidelines for and constraints on investment of the Fund (the “Investment Policy Statement”) and all other documents governing the investment and overall management of the Fund.

• At least annually, evaluate the target for Fund levels for appropriateness given business and operating environment risks and opportunities.

• At least annually, gather relevant input from the Finance Committee regarding risk tolerance and key Fund portfolio characteristics, including but not limited to expected return, volatility, duration and liquidity.

• In light of the foregoing information and evaluation, evaluate whether there are any necessary or desirable changes to be made to the Investment Policy Statement (including the Asset Allocation Guidelines set forth therein) or other applicable governing documents.

Investment Performance, Investment Service Providers and Costs • Review the investment performance of the Fund relative to its performance

benchmarks on a quarterly basis. • Monitor and evaluate investment managers for the Fund at least quarterly; • Determine whether investment consultants, managers, custodians and any other

service provider with respect to the Fund should be retained or replaced and take appropriate action with respect to the same.

• At least annually, assess whether fees incurred by or on behalf of the Fund portfolios are appropriate and reasonable.

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Oversight of Implementation of Investment Policy Statement • At least quarterly, ensure compliance with the Investment Policy Statement by verifying

that Fund balances are invested accordingly. • Ensure operational functions, including, but not limited to, rebalancing and reserve

funding, are performed appropriately by UW Health Staff or its designee.

Other Duties and Responsibilities of the Committee • Review, at least annually, the Investment Sub-Committee’s charter and recommend any

proposed changes to the Finance Committee for approval. • Review, at least annually, the Investment Policy Statement (including the Asset

Allocation Guidelines therein) and recommend any proposed changes thereto to the Finance Committee for approval.

• Report formally to the Finance Committee at least annually on the Investment Sub-Committee findings and recommendations.

• Be responsible to the Finance Committee and maintain minutes or other records of the Investment Sub-Committee meetings and activities.

• Ensure that the Fund is managed in accordance with any applicable laws and/or regulations.

• Such other responsibilities regarding the Fund as may be delegated to the Investment Sub-Committee from time to time by the Finance Committee.

Authority to Engage Advisers On an annual basis the Finance Committee will review the performance of the Fund, investment managers, investment custodians and investment consultants in coordination with the Investment Sub-Committee. The Investment Sub-Committee has authority to retain and replace investment managers when it deems appropriate, and shall have authority to approve fees and terms of retention, without the prior permission of the Finance Committee, and shall be provided the necessary resources for such purpose. Executive Liaison The management liaison to the Investment Sub-Committee is the Chief Financial Officer of UWHCA.

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Resolution

Investment Committee Policy and Charter

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RESOLUTION OF THE BOARD OF DIRECTORS


Approving UW Health Investment Sub-Committee, UW Health Sub-Committee Charter and Investment Policy Statement

WHEREAS, the Finance Committee of the University of Wisconsin Hospitals and

Clinics Authority (“UWCHA”) Board of Directors (the “Board”) is charged with the oversight and management of UW Health’s investment portfolio; and

WHEREAS, on May 26, 2016, the Board accepted the Finance Committee

recommendation to create an Investment Sub-Committee as a standing sub-committee of the Finance Committee to oversee the enterprise’s investment management; and

WHEREAS, in connection with the creation of the Investment Sub-Committee, on

December 21, 2017, the Finance Committee approved the UW Health Investment Policy Statement (the “IPS”) and Investment Sub-Committee Charter (the “Charter”) as prepared, presented and recommended to the Finance Committee by UW Health management and resolved to recommend the approval of the IPS and Charter by the Board; and

WHEREAS, the Board has reviewed and discussed the IPS and the Charter as approved

and recommended by the Finance Committee and has determined it to be in the best interests of UW Health to approve the IPS and the Charter as approved and recommended by the Finance Committee;

NOW, THEREFORE, BE IT RESOLVED, that the IPS and the Charter in substantially the form approved and recommended by Finance Committee are hereby approved, with such changes as the UW Health CEO or his delegates deem necessary or appropriate in furtherance of the resolutions set forth herein;

FURTHER RESOLVED, that the UW Health CEO, and his delegates are hereby

authorized and directed to take any and all actions, and to execute, deliver, and perform any and all agreements and other documents in the name of and on behalf of UW Health as they deems necessary or appropriate in furtherance of the matters contemplated by these resolutions;

FURTHER, RESOLVED, that any and all lawful actions previously taken by UW

Health management in furtherance of the matters contemplated by these resolutions are hereby ratified, confirmed and approved in all respects.

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FYI Attachment

UW OTD CY 2018 Quality Assessment and

Performance Improvement Plan

Approved by UWHCA Executive Committee December 21, 2017

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CY 2018 Quality Assessment and Performance Improvement Plan

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CY2018 Quality Assessment and Performance Improvement Plan

Approval Date: March 2008 Revision Date: December 2017

Table of Contents Section I: Introduction to UW Organ and Tissue Donation and QAPI Program ...................................................................... 2

Scope and Purpose of the QAPI Program ........................................................................................................................... 2 UW Health & UW OTD Mission / Vision .............................................................................................................................. 3 UW OTD Strategic Priorities ................................................................................................................................................ 3 UW OTD QAPI Program Goals & Objectives ....................................................................................................................... 3 Confidentiality, Corporate Compliance, & Third Party Service Agreements and Contracts ............................................... 4

Section II: QAPI Program Governance: Leadership, Governance, and Structure ................................................................... 4 Roles & Responsibilities ...................................................................................................................................................... 4 Committee Structure .......................................................................................................................................................... 6 Communication ................................................................................................................................................................... 6 Stakeholder Engagement .................................................................................................................................................... 7

Section III: Components of the QAPI Program ........................................................................................................................ 8 Individual Departmental Commitment to Quality .............................................................................................................. 8 UW OTD Performance Improvement Activities .................................................................................................................. 8 Corrective and Preventative Action (CAPA) System ........................................................................................................... 9

Section IV: Quality Data Systems: Development, Measurement, Monitoring & Assessment .............................................. 10 Data methodology ............................................................................................................................................................ 10 Quality Assessment and Assurance Activities ................................................................................................................... 10 Objective Measures & Quality Indicators ......................................................................................................................... 11

Section V: Summary and Approval ....................................................................................................................................... 11 References......................................................................................................................................................................... 11 Annual Approval ................................................................................................................................................................ 11

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Section I: Introduction to UW Organ and Tissue Donation and QAPI Program Scope and Purpose of the QAPI Program University of Wisconsin Organ and Tissue Donation (UW OTD) is a hospital-based non-profit organ procurement organization established in 1984. As designated by the federal government, UW OTD manages all organ donation activities for the majority of the state of Wisconsin and portions of upper Michigan and northern Illinois. The donation service area covers 66 counties and 103 hospitals. UW OTD professional staff is available 24/7 to support the end-of-life process, evaluate, manage, recover, preserve, and provide organs for transplantation. Beginning in December 2011, UW OTD expanded services to offer hospital development for tissue donation to hospitals in its donation service area interested in streamlining services. Tissue services provided by UW OTD are limited to professional education and performance improvement initiatives in order to best serve hospital partners and donor families. UW OTD is dedicated to increasing the community’s awareness and sending a call to action to help alleviate the organ shortage and to improve quality of life through transplantation. To foster this commitment, UW OTD partners with donor hospital stakeholders through local improvement initiatives such as the development of a UW OTD onsite consent resource and active membership in Donate Life Wisconsin, including their DMV and marketing workgroups. These collaborations provide community and professional education, sponsor donor awareness events, and promote a positive donation focus in the media. Additionally, UW OTD is committed to honoring donors and their families through recognition and support programs such as the annual Gift of Life ceremony traditionally held at the Wisconsin Governor’s mansion each summer. UW OTD is an integrated part of the University of Wisconsin Health (UW Health) Organ Donation and Transplant Service Line and partners with the transplant center on a variety of initiatives to strengthen the value and effectiveness of our shared services. The UW OTD Quality Assessment and Performance Improvement (QAPI) Plan facilitates organization-wide participation that is committed to raising the standards of performance and ethical behavior while serving donor families, donor hospitals, recipients and those waiting for a transplant. As a part of UW Health, UW OTD aligns with and supports the mission, vision, values of the service line and collaborates with the UW Health Quality, Safety and Innovation (QSI) Department. One of UW Health’s strategic goals is to be clearly distinguished as the quality and patient safety leader in the nation. Further, UW OTD believes that quality is:

▪ A core accountability of all UW OTD employees ▪ Doing things right the first time ▪ Providing the best service or product to our customers to meet and exceed expectations ▪ Continuously searching for ways to innovate and improve daily operations ▪ Meeting and exceeding performance targets to raise the bar of excellence.

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UW Health & UW OTD Mission / Vision UW Health’s vision is Remarkable Healthcare. UW Health’s mission is advancing health without compromise through:

• Service • Scholarship • Science • Social Responsibility

UW OTD has defined the following mission and vision to further address the unique practice of our organization. Mission: UW OTD advocates for donors, donor families, and recipients and educates healthcare professionals and the public to enrich and save lives through organ and tissue donation. Vision: Universally recognized as a preeminent organ procurement organization, we will identify and maximize every opportunity to save lives through organ donation. Further, the QAPI Plan will align with and support the key strategic priorities of UW OTD: UW OTD Strategic Priorities The strategic priorities are evaluated and assessed in a variety of ways across the phases of organ procurement, including but not limited to: Strategic Priority Measurement Effective next of kin consent process Consent rate

Regulatory and True Conversion rate High quality donor family care Donor family questionnaire results Maximize the donation Observed to Expected (O/E) Organs Transplanted Improve Employee Engagement Employee Turnover & Retention Rate Expand the donor registry Number of FPA Donors and Referrals Per Year UW OTD QAPI Program Goals & Objectives The overall goal of UW OTD’s QAPI program is to improve the performance of organ and tissue donation activities. This aligns with UW Health’s organizational quality improvement philosophy. The objectives of the QAPI Program are to:

• Utilize data to drive improvement: UW Health and UW OTD have an abundance of objective process and objective outcome data to assist decision making. The UW OTD’s DonorLink is the primary platform for collecting and evaluating performance date. Performance data generated from DonorLink is shared with staff

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and faculty across the service line. Benchmarking is utilized to support decision making and assist with setting goals.

• Foster a culture of safety and continuous quality improvement: Maintaining quality and safety requires vigilance and effort. The mindset is exemplified by our organization's commitment to increase voluntary incident reporting and ensure all employees utilize the UW Health Improvement Network (UWHIN) performance improvement framework to solve problems.

• Use proven improvement principles and processes: The program utilizes the organizational UWHIN resources to carry out improvement work. UWHIN provides a set of guiding principles, an education program tailored to the varied needs of UW Health, and the framework to apply improvement concepts that lead to improved outcomes.

• Ensure accountability: Quality and safety issues are reviewed by OTD Leadership at the UW OTD Regulations and Standards Committee. UW OTD Managers review all adverse event reports and occurrences. The UW Healthcare Event Evaluation Team (HEET) ensures severe safety issues are addressed by the appropriate administrative team.

Confidentiality, Corporate Compliance, & Third Party Service Agreements and Contracts Confidentiality All internal information that includes but is not limited to donor and recipient data, personnel records, accounting records, and quality assurance and occurrence data is privileged and confidential information. UW OTD employees who access this information in order to perform assigned duties are expected to treat materials with care and consideration for privacy as outlined in UW Health policy. Corporate Compliance UW OTD exercises due diligence in complying with all legal and regulatory requirements related to donation. Additionally, UW OTD seeks to detect and prevent unlawful and/or unethical conduct by its employees. UW OTD participates in the overall UW Health Corporate Compliance program, which ensures that Conflicts of Interest are assessed and disclosed if needed, annually by all staff and advisory board members. Third Party Service Agreements and Contracts UW OTD Leadership in collaboration with UW Health resources is responsible for the oversight of current agreements and contracts with third party agencies. Suppliers of these products or services can affect the quality and/or safety of donation services and may be evaluated based on their ability to perform in accordance with specified requirements. UW OTD will maintain a list of third party agreements and contracts. Section II: QAPI Program Governance: Leadership, Governance, and Structure Roles & Responsibilities Role Responsibility Director, Organ Donation and Transplant Service Line

Provides leadership, oversight, and supervision of service line wide activities. Works collaboratively with UW Health leadership, Organ Donation and Transplant Directors, Managers, and other hospital staff to move process improvement and major service line initiatives forward and ensures that all regulatory standards are being met within the UW OTD.

UW OTD Executive Director Assumes organizational responsibility for implementation of the UW OTD QAPI plan, monitors and shares process and outcome measures to evaluate the quality of activities performed, and works with the Director of the Organ Donation and Transplant service line to provide adequate resources and staffing.

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UW OTD Medical Director Provides guidance and clinical oversight on the evaluation of potential organ donors and provides leadership to improve the number of organs transplanted per donor. Supports donation service area performance improvement initiatives aimed at maximizing true potential and successful reaccreditation and preparation for regulatory surveys.

UW OTD Leadership Team: Executive Director; Medical Director; all Managers and the Senior Organ Procurement Coordinator

Prioritizes, oversees, and reviews UW OTD improvement initiatives and performance indicators and ensures appropriate resources are deployed to performance improvement teams.

UW Organ Donation and Transplant Program Director for Performance Excellence

Leads and oversees the implementation of the QAPI Plans for the UW Health Organ Donation and Transplant Service Line. Provides ongoing communication, quality training, and education for UW OTD staff and provides resources for performance improvement initiatives and projects. Leads the review and update of the plan annually. Reports performance improvement activities to the Organ Donation and Transplant Service Line and UW Health leadership.

UW OTD Multidisciplinary Staff Learns the methodology for improvement and participated in performance improvement activities as needed, and identifies opportunities for improvement through stakeholder engagement activities, occurrence reporting, and quality assessment and assurance activities.

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Committee Structure Committee Responsibility UW OTD Regulations & Standards Committee (“Ready for Regs”)

Responsible for ensuring compliance with all internal and external policies, laws, and standards and assuring high quality work and outcomes. This committee has the authority to review and make recommendations for changes in UW Organ and Tissue Donation policies, procedures, and plans and has final oversight of UW OTD Emergency Operations Plan and the UW OTD Quality Assessment and Performance Improvement Plan. This committee serves as the QAPI Committee for UW OTD and on a quarterly basis, reviews data related to occurrences and quality improvement, as well as the status of improvement projects.

UW OTD Advisory Board May provide recommendations regarding performance improvement projects or initiatives. Provides professional advice and/or recommendations for organ and tissue donation activities. Reviews the plan annually.

UW Health Transplant QAPI Steering Committee

Provides leadership and oversight for QAPI efforts of the Organ Donation and Transplant Service Line. Performance measures, improvement projects, and patient safety data are shared. The committee includes representation from medical and surgical staff from all organ programs, hospital leadership, hospital quality, transplant managers, UW OTD, operating room, and coordinated care. Minutes go to Patient Safety and Quality Committee of the UW Hospitals and Clinics Authority (UWHCA) Board.

UW Health Quality, Safety and Innovation Department

Supports the UW OTD QAPI Plan by providing resources and educational opportunities as appropriate. Additionally, UW OTD collaborates with and gives updates as requested.

UWHC Authority Board Serves as a governing body for UW OTD. Reviews the overall performance of UW OTD annually. Reviews and approves the QAPI plan annually.

Communication Morning Report and Shift Handoff These activities provide a standardized approach to transfer patient care activities and communicate important announcements and events among the UW OTD team. It also provides an opportunity to debrief about any activity occurring from the previous day (or weekend). UW OTD staff members conduct twice daily organ procurement shift-handoff discussions that are open to all staff to participate. An all-staff morning report occurs Monday through Friday. Daily Leadership Team Huddles The leadership team also huddles daily Monday through Friday to review any operational needs (staffing, volume, customer service concerns, patient or staff safety issues, etc.) in order to prioritize and resource them accordingly. Service Line Huddle The Organ Donation and Transplant Service Line huddle occurs every morning to collect information from various internal stakeholders directly within the service line and internal hospital resources aligned with the service line. The information collected from the huddle is cascaded down to each program within the service line to proactively address issues.

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UW Health Transplant Morbidity and Mortality (M&M) Conference On a weekly basis, the UW Health transplant surgical team facilitates a learning discussion of all cases performed in the previous week, inclusive of primary transplant operations, re-operations, or other surgical procedures performed in the pre and/or post-transplant phase. A representative of the UW OTD team participates to represent any aspect of the organ recovery process, such as surgical errors and other technical or procedural issues. Stakeholder Engagement UW OTD’s relationships with its stakeholders are measured in a variety of qualitative and quantitative ways. Designated Requestor Program Evaluation Trained and certified Designated Requestors are an essential component to the successful consent rate of the UW OTD service area. On-going innovations and improvements are made to the training program for designated requestors to adapt national best practices on effective requesting. The Hospital and Community Development Manager oversees the administration and recertification of the program for the >800 requestors in the service area. Certified designated requestors have limited opportunity to practice their consent conversation skills since donation is such a low frequency event. Thus, based on best practices in the field and feedback from our hospital partners, UW OTD implemented Consent Workshops using simulated scenarios and actors so designated requestors can increase their experience, comfort, and competence in holding these conversations. The evaluations from participants have demonstrated the need for such an advanced training and the course has become a standard UW OTD course offering. Donor Family Questionnaire Every donor family is offered the opportunity to complete a survey about their donation experience. Analysis of this feedback data provides insight into on-going opportunities for performance improvement in the UW OTD donor family care process. Hospital Feedback Survey Donor hospital staff members directly involved in donation opportunities are sent a survey in which to provide feedback on the case. Surveys may be submitted anonymously. Individual follow-up with donor hospital staff members is done on a case-by-case basis or as requested. Aggregate data may be analyzed to identify on-going opportunities for performance improvement in hospital development activities. After Action Reviews (AAR) UW OTD adapted the AAR framework, based on the work of Nancy Dixon and her book Common Knowledge: How Organizations Thrive by Sharing What They Know, to conduct a learning conversation with the appropriate UW OTD and donor hospital staff involved on donor cases. The AAR framework is used to identify how processes can be improved, foster questions about practices and outcomes, create accountability for follow-up on action items, and identify best practices in donation. The purpose is to translate learning into actions that generate improvements in the donation process. When the donation is a shared organ and tissue case, tissue donation discussions and dispositions are also incorporated for the donor hospitals receiving tissue services from UW OTD. Monthly Donor Hospital Dashboards Targeted donor hospitals are provided a monthly dashboard of organ donation activity with outcome metrics by a member of the UW OTD Hospital Development Team. In instances where UW OTD also provides tissue services for that hospital, tissue data is also shared. In collaboration with donor hospital staff, the dashboard analysis is used to guide improvement initiatives at the donor hospital. Dashboards are also shared with hospitals with lower donor volume either bi-annually or annually, depending on overall donation potential. UW OTD Tissue and Eye Partners

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The UW OTD regularly collaborates with tissue and eye partners throughout the donation service area. In addition to cooperative outreach initiatives through our membership in Donate Life Wisconsin, UW OTD also is a contractual partner of BloodCenter of Wisconsin/Wisconsin Tissue Bank and provides hospital development services on their behalf for hospitals with which they have contractual agreements. UW OTD participates in partner audits by tissue and eye banks as requested. All UW OTD staff work to facilitate successful recovery of tissue and eyes by sharing infectious disease reports and collaborating whenever possible on shared cases. Section III: Components of the QAPI Program Individual Departmental Commitment to Quality Each department within UW OTD has a commitment to providing quality services and continuous performance evaluation and improvement. Each manager is a member of the UW OTD Regulations and Standards Committee and the UW OTD Leadership Team. Most UW OTD staff are divided among three teams:

• Clinical and Donor Family Services • Surgical Recovery and Preservation • Hospital Development and Community Outreach

UW OTD Performance Improvement Activities Identifying and Selecting Performance Improvement Projects Each member of the UW OTD can submit a request for resources when a quality improvement project is identified. An intake form is available on the Organ Donation and Transplant intranet site for staff and faculty members to complete and submit to the manager of their program. Resources required for quality improvement vary based on the program, need, severity, and scope of other initiatives occurring in the UW OTD, service line and hospital-wide. Identifying the key areas to use resources for quality improvement takes into consideration the following:

• Quality monitoring, feedback, and assessment data to identify performance gaps against internal benchmarks, national averages, expected results, and best practices

• Areas of high risk, high or low volume activities, and issues prone to scrutiny (higher volume or riskier programs may require more quality improvement resources than others)

• Routine internal audits performed to identify improvements and to ensure compliance • Patient Safety Net (“PSN”) reports reviewed by managers used to identify safety risks or trends • Recommendations or concerns voiced by hospital partners • Ease of implementation and the overall impact of the improvement are determined by utilizing a prioritization

matrix. Projects are prioritized and assigned resources by the UW OTD Leadership Team. Executing, Monitoring, and Sustainment of Performance Improvement Activities Methodology UW OTD follows FOCUS-PDCA using an A3, which is the standard improvement methodology endorsed by UW Health. This approach takes an improvement from development through testing to sustainment. The UW Health Improvement Network (UWHIN) provides templates and instructions for following this methodology, and relevant tools and techniques.

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Sustainability Sustainability of interventions is a critical component of the improvement process. If an intervention or change idea positively impacts a process, outcome, and/or other aspects of the system, the next step is to determine if it can be sustained by current resources. To promote sustained improvement, a Sustainability Plan is created and executed by each improvement team or operational leader. Quality Improvement Education To continually improve how we utilize the FOCUS-PDCA methodology and improvement tools and techniques, UW OTD participates in Quality Improvement Education “Lunch and Learn” with the Organ Donation and Transplant Service Line Managers and Directors. These monthly sessions provide an informal setting to:

• Share challenges and successes, • Learn together and from each other, • Introduce content in real-time as much as possible (i.e. sustainability planning), and to • Speak the same quality improvement language.

Corrective and Preventative Action (CAPA) System Occurrence Reporting System Based on UW OTD policy on occurrence reporting, the UW OTD uses a comprehensive occurrence reporting system to identify, report, document and conduct analysis of occurrences, including complaints and / or investigations. UW OTD utilizes the Patient Safety Net (PSN) software application provided by UW Health to report occurrences. For all PSNs, reporters complete a description of the event and the description is reviewed by managers. Severity Level of Occurrences: High Harm -Score 6 Events categorized as such would involve the loss of an organ or donation opportunity. These events, should they ever occur, would be considered catastrophic. All events with a score of 6 or higher are reviewed by the multidisciplinary hospital Healthcare Event Evaluation Team (HEET). A formal root cause analysis may be recommended as a result of this review. Root Cause Analysis (RCA) is a formal process of identifying and minimizing the re-occurrence of specific root causes and contributing factors relating to an adverse or sentinel event. Medium Harm -Score 4 These events involve anything that negatively impacts critical elements of the donation process by creating a significant delay or effect on outcomes or processes, a family complaint, or a confidentiality breach. The UW OTD Leadership team may recommend an internal root cause analysis. If a root cause analysis is performed, the results of the analysis and the action plan developed to prevent recurrences will be communicated to the UW OTD Leadership Team and affected roles. Changes implemented are incorporated into UW OTD programs’ policies and practices to prevent repeat incidents. Low Harm -Score 1 These events have the potential to negatively impact the donation process and/or are deviations from standard practice. All data in this category are tracked and trended. On quarterly basis at the UW OTD Regulations & Standards Committee, the data is presented on an aggregate level. A process improvement project will be initiated if a trend occurs, or if directed by of one of the above committees.

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Section IV: Quality Data Systems: Development, Measurement, Monitoring & Assessment Data methodology UW OTD has a full time staff member dedicated to managing data and data systems. Data is systematically collected for improvement priorities, ongoing measurement, and goal setting. Data is collected from the Scientific Registry of Transplant Recipients (SRTR), United Network for Organ Sharing (UNOS), the Association of Organ Procurement Organizations (AOPO), and developed from internal sources. Data received from external sources is validated. Data is collected and compiled quarterly by the senior data coordinator and shared with all staff, including leadership. Improvement projects and new initiatives are supported and measured by data. Quality Assessment and Assurance Activities Quality Assurance (QA): Medical (Death) Record Review, Deceased Donor Registry, Death Record Reconciliation UW OTD performs a variety of quality assurance audits to ensure that data submitted is complete and accurate, referrals are not missed, and hospitals are compliant with death reporting regulations. The QA is multidisciplinary, conducted by administrative staff, Organ Procurement Coordinators, Hospital Development Specialists, Surgical Recovery staff, and others. Commonly occurring outcomes and / or trends from these reviews are reported at the UW OTD Regulations and Standards Committee. Medical (death) record reviews are conducted monthly, quarterly, or annually, depending on the hospital classification. If needed, action plans are implemented to improve performance, per UW OTD hospital development policy. Regulatory Compliance UW OTD complies with and is surveyed by the United Network for Organ Sharing (UNOS) and Centers for Medicare and Medicaid Services (CMS). UW OTD also complies with and is surveyed by the Association of Organ Procurement Organization (AOPO), a peer-accrediting agency for organ procurement organizations. UW OTD is a hospital-based organ procurement organization and thus, complies with the applicable hospital regulations under the direction of UW Health. UW OTD also collaborates with tissue and eye bank partners for shared services and complies with the applicable regulations under the direction of the tissue and eye banks. UW OTD staff is provided regulatory training as needed. Environmental Safety UW OTD and UW Health have policies to guide employee practice and ensure workplace safety and appropriate follow-up for injuries and illnesses. All UW OTD staff members complete annual safety and infection control training offered by UW Health. All UW OTD owned equipment, facilities and supplies that affect the quality of recovered organs are inspected, stored, cleaned, and maintained according to manufacturer’s recommendations and regulatory standards. Supplies are stored properly with quantities and expiration dates monitored to determine usage and prevent outdated stock. The Manager of Recovery and Preservation Services is responsible for overseeing this process in conjunction with the Preventative Maintenance Program of UW Health Facilities and Engineering Services and external vendors. The Manager of Recovery and Preservation Services also oversees and manages all aspects of safety related to organ recovery and preservation processes. Staff Education, Development, and Competency UW OTD provides department and role-specific new employee orientation in addition to the orientation program offered by UW Health and offers ongoing education and development opportunities to all employees. Additionally, core competency requirements for each job description are reviewed with each new employee to assure an appropriate level of mastery is achieved and maintained. This is documented in the UW OTD Employee Orientation Checklist and Core Competency Assessment. Managers conduct annual needs assessments with each employee to identify on-going areas for development. A variety of training opportunities are offered by UW Health Learning and Development and external organizations. All training activities are documented in employee training records per UW OTD policy. UW OTD staff

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receive annual training on sensitivity and family interactions not only through UW Health Compliance training, which focuses on privacy and patient interactions, but also through role-specific training as well such as Crucial Conversations and Grief Resources for Donation Support Specialists. Objective Measures & Quality Indicators The below objective measures in all phases of the procurement process are utilized to evaluate and compare over time UW OTD’s monthly performance with regard to procurement activities and outcomes. The results of these indictors and their established benchmarks are presented quarterly at UW OTD Staff meetings and to the UW OTD Advisory Board.

Phase of Organ Procurement

Objective Measure Goal Red line Location

Pre DSS On-Site Rate >=75% NA DSS On-Site Report

Pre Regulatory (Collaborative) Conversion Rate

NA NA Local Donor Scorecard

Peri True Conversion Rate >=75% <=60% Local Donor Scorecard

Peri Tissue Consent Rate >=60% <=39% Tissue Dashboard

Post Organs Transplanted per Donor SCD 4.25 ECD 2 DCD 2.5

NA Local Donor Scorecard

Post Observed to Expected Organs Transplanted Per Donor

>=1.2 <1.0 (national average)

Local Donor Scorecard

Post Research Organs per Donor 1 NA Local Donor Scorecard

Section V: Summary and Approval The UW OTD QAPI Plan is intended to serve as a guideline for the program to monitor, drive, and sustain improved performance outcomes.

References UWHC Quality Assessment and Performance Improvement Plan (Updated 8/3/2017) Organ Transplant Quality Assurance and Performance Improvement Plan (Fiscal Year 2018) UW Health Improvement Network (UWHIN), downloaded 11/24/2017 from intranet site Annual Approval

____________________________________ Michael E. Anderson, PA-C Executive Director UW Organ and Tissue Donation 12/8/2017 Date

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FYI Attachment

UW OTD CY17Annual Summary Report

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CY2017 Annual Summary Report

Page 1 of 7

According to a 2006 resolution of the University of Wisconsin Hospital and Clinics Authority Board, the Executive Director of University of Wisconsin Organ and Tissue Donation (UW OTD) is required to provide an annual report regarding its services and performance. The following report provides a summary of UW OTD organizational priorities, performance, and improvement initiatives (see CY2018 Quality Assessment and Performance Improvement Plan), a regulatory compliance update, highlights and important data from CY 2017. UW OTD BACKGROUND UW OTD is a hospital-based, federally designated Organ Procurement Organization (OPO) that provides the coordination of life-saving organs for transplantation. UW OTD provides service to 108 hospitals throughout the states of Wisconsin, Michigan, and Illinois. UW OTD is one of 58 OPOs in the U.S. with the responsibility to:

provide education and training, ongoing support, and collaboration for physicians, nurses, and other health care professionals involved in the organ and tissue donation process;

facilitate the consent process; determine donor suitability; provide medical management to improve organ function in the deceased donor patient; facilitate the surgical recovery of the organs; provide ongoing effective care to the donor family during and after the donation, and provide and coordinate education in the communities throughout the UW OTD service area.

Mission Statement: UW OTD advocates for donors, donor families, and recipients and educates the healthcare professionals and the public to enrich and save lives through organ and tissue donation.

Vision Statement: Universally recognized as a preeminent organ procurement organization, we will identify and maximize every opportunity to save lives through organ donation.

UW OTD CONNECT TO PURPOSE

We start every staff and faculty gathering with a Connect to Purpose, to remind us of the donors, patients, families, and hospital partners who drive us towards excellence. Our Connect to Purpose for this summary report, comes from the wife of a liver donor who wrote to the transplant recipient about her young son’s reaction to seeing a picture of the recipient and his son.

“I shared your letters and pictures with him. He looked at your son and said, ‘So his Dad would have died, if my Dad didn’t give him his liver?’ I told him that was true; he smiled and said ‘That’s cool.’ Our son knows the pain

of losing a Dad, and I know that he does not want any other kid to feel that loss.”

UW OTD ORGANIZATIONAL PRIORITIES

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UW OTD PERFORMANCE (Data Charts Attached)

UW OTD Summary of Highlights and Trends

Nationally recognized for high donation rates: o A regulatory conversion rate that is consistently above the national average o Ranked number one in the U.S. for conversion rate

Ranked in the top 10 for the past 12 consecutive years o One of only 12 OPOs worldwide to be internationally recognized for the high performance o 2nd highest percent increase in the number of organ donors nationally (2015-2016).

Nationally recognized for high organ utilization rates: o Ranked # 1 in the U.S. for the overall organ utilization rate o Ranked # 2 in U.S. for liver and pancreas utilization

High performing state donor registry : o Consistently performs above the national average for donor registries.

Expanding tissue services throughout the service area: o Negotiations are currently underway to increase in the number of hospital contracts in 2018.

Celebrated and honored over 322 donor family members at the Gift of Life Ceremony held at the State of Wisconsin Executive Residence

Recognized and celebrated 16 hospitals in UW OTD donation service area (DSA) who received the Award of Hope

Hosted nearly 300 attendees at the 16th Douglas T Miller Symposium on Organ Donation and Transplantation

UW OTD IMPROVEMENT INITIATIVES

Reference the attached CY2018 Quality Assessment and Performance Improvement (QAPI) Plan

UW OTD ADMINISTRATIVE AND POLICY UPDATE

UW OTD policies were reviewed for update in 2017. UW OTD policy development is governed by UW Health Policy 1.10, UW Health Administrative (Non-clinical) Policies - Development, Revision, Retiring and Approval.

REGULATORY COMPLIANCE UPDATE

Center for Medicare and Medicaid Services (CMS) o Last routine onsite survey was completed in July 2014 (four year cycle) o Re-certified with no deficiencies noted o In compliance with all continuously monitored outcome and reporting measures o Next survey scheduled for 2018

United Network for Organ Sharing (UNOS)

o Last routine onsite survey was completed in November 2016 (three year cycle) o Actively completing survey follow up procedures o Anticipate UW OTD will remain a member in good standing

Association of Organ Procurement Organizations (AOPO)

o Last routine onsite survey was completed in February 2015 (three year cycle)

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o Received full accreditation o Voluntary member association o Next survey scheduled for 2018

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ATTACHMENT: UW OTD PERFORMANCE AND PROJECTED 2017 DATA CHARTS

Referral Rate:

* The rate for January – November of 2017 is 97%.

96 86 94 91 80 118 112

40 29

32 36 26

32 38

136

115 126 127

106

150 150

0

20

40

60

80

100

120

140

160

2011 2012 2013 2014 2015 2016 Projected2017

UW OTD Deceased Donors

DCD

BDD

TOTAL

92% 95% 85% 90% 88%

95% 89%

77% 77% 76% 77% 77% 77% 75%

0%

20%

40%

60%

80%

100%

2011 2012 2013 2014 2015 2016 Projected2017

Collaborative Conversion Rate

UW OTD

National

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UW OTD National Rank and Performance

394 366 415 403

346

457 458

0

100

200

300

400

500

2011 2012 2013 2014 2015 2016 Projected2017

UW OTD Organs Transplanted

24% 25%

40% 45% 45%

53% 50%

0%10%20%30%40%50%60%

2011 2012 2013 2014 2015 2016 Projected2017

UW OTD First Person Authorization (Registry) Donors

65

126

162

200 211

157

0255075

100125150175200225

2012 2013 2014 2015 2016 Projected2017

UW OTD Tissue Donors

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Performance data based upon 2-Year Cohort January 1, 2014 – December 31, 2015 Source: AOPO Multi-Use Data Tool as of 09/26/2017

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GLOSSARY OF TERMS

Award of Hope An award presented annually to hospitals throughout the UW OTD donation service area (DSA) who have exhibited exemplary leadership and commitment to organ donors, donor families, and the nearly 125,000 individuals on the nations transplant waiting list. To be eligible for the Award of Hope, hospitals must have at least four eligible donors in the previous 12 month period.

Gold Award: OTPD of at least 3.25 and a conversion rate of at least 75%. Silver Award: A conversion rate of at least 75%. Bronze Award: OTPD of at least 3.25.

Regulatory Conversion Rate The percentage of times a death meeting eligible death criteria becomes an actual donor. Donation Support Services Based on national best practices and an 18+ month pilot study, UW OTD now supports referring hospitals and families onsite with a donation resource to help facilitate end-of-life conversations and answer questions about the donation process. First Person Authorization Legislation allows donor designation to be indicated on a driver's license or an official signed donor document, which gives legal authority to proceed with organ procurement without consent from the family. Gift of Life Ceremony An event that demonstrates the State of Wisconsin’s support for organ donation by recognizing and thanking donor families for their decision to honor their loved one at the time of their death to be an organ donor. The event is held annually at the State of Wisconsin Executive Residence. Organs Transplanted Per Donor (OTPD) The number of organs recovered and transplanted from each organ donor. The maximum number of organs that could be recovered from each donor is eight. The 2015 national average is 3.03. Note- not all donors are medically eligible to donate all eight organs. Tissue Donor An individual for whom at least one tissue was recovered for purposes of transplantation. Tissues include: corneas, heart valves, ligaments, saphenous veins, and tendons.

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X UWHCA Board of Directors January 25, 2018, 1:30 - 4:30 PM Room H6/215 - Home | UW Health · 2018....

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Transcript of X UWHCA Board of Directors January 25, 2018, 1:30 - 4:30 PM Room H6/215 - Home | UW Health · 2018....