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        <FormAndLineReferenceDesc>Part I, Line 1a</FormAndLineReferenceDesc>
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        <FormAndLineReferenceDesc>Schedule K, Part IV Arbitrage, LN 2c</FormAndLineReferenceDesc>
        <ExplanationTxt>Bond A: Issuer Name: North Carolina Medical Care Commission Date the Rebate Computation was Performed: 06/01/2016 Bond B: Issuer Name: North Carolina Medical Care Commission Date the Rebate Computation was Performed: 05/01/2017 Bond D: Issuer Name: North Carolina Medical Care Commission Date the Rebate Computation was Performed: 06/01/2019</ExplanationTxt>
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        <RelationshipDescriptionTxt>Ernest L. Evans (Board Director)</RelationshipDescriptionTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part III, Line 4a</FormAndLineReferenceDesc>
        <ExplanationTxt>Overview of University Health Systems of Eastern Carolina d/b/a Vidant Health (VH): At Vidant Health ("VH"), we are committed to improving the health of our communities. Eastern North Carolina residents look to our hospitals for quality health care. We work hard to uphold the trust that our communities place in us. Through a clear vision, disciplined leadership and committed employees, VH serves the needs of the region, including those who are underserved and need us the most. Our mission at VH to enhance the quality of life for the people and communities we serve, touch and support, drives us far beyond caring for patients within the confines of our hospital walls. It calls us to help make eastern North Carolina a better, healthier place to live. VH is a North Carolina non-profit corporation with headquarters in Greenville, North Carolina. VH and its affiliates operate an integrated health care delivery system that serves a total market of approximately 1.4 million people in 29 contiguous counties in eastern North Carolina. The Health System includes hospitals, physician practices, outpatient services, long-term care, home health, hospice, and wellness services. The Health System's owned hospitals are Vidant Medical Center ("VMC"), which is a tertiary care hospital and an academic medical center, and eight other acute care hospitals: Vidant Roanoke-Chowan Hospital, Vidant Edgecombe Hospital, Vidant Chowan Hospital, Vidant Bertie Hospital, Vidant Duplin Hospital, Vidant Beaufort Hospital, The Outer Banks Hospital, and Halifax Regional Medical Center. VMC serves as the teaching hospital for the Brody School of Medicine, East Carolina Schools of Nursing and Allied Health and Pitt Community College. The system also serves as a regional referral center for eastern North Carolina. The System's nine owned acute care hospitals are licensed to operate 1,708 beds. Each hospital is licensed by the Division of Facility Services of the North Carolina Department of Health and Human Services and approved as a provider by the Medicare and Medicaid programs. VH and its hospitals and affiliate organizations provide services to patients without regard to their ability to pay. In fiscal year 2020 VH's combined patient care statistics were: inpatient admissions, 67,974; inpatient days of care, 368,576; surgeries, 45,845; births, 6,558; and Outpatient visits, 397,266. Our System's workforce included 12,592 employees. Each of VH's hospitals operates an emergency room, which is open 24 hours a day. VMC also offers a full spectrum of trauma Services. Emergency and trauma services are provided to patients without regard to their ability to pay. In fiscal year 2020 VH provided care to 262,808 emergency room patients. VH's Board of Directors consists of 11 voting members, six of whom must be current or former Pitt County, North Carolina appointees of VMC's Board of Trustees and five of whom must be current or former Board of Governors of the University of North Carolina appointees of VMC's Board of Trustees. VMC, in affiliation with the Brody School of Medicine, which is owned by the State of North Carolina, operates 30 resident-training programs with over 400 medical residents. This Relationship enables VMC and the Brody School of Medicine to combine their resources for the provision of quality patient care, medical education and research for the residents of eastern North Carolina. The Brody School of Medicine has three important goals: educating primary care physicians, making medical care more readily available to the people of eastern North Carolina, and providing opportunities to minority and disadvantaged students. As a non-profit organization, VH reinvests all excess of revenues over expenses in programs, services, and facilities that provide access to patient care and health services to the citizens of Eastern Carolina. Overview of Vidant Health Community Benefit Programs 1. Eastern North Carolina is comprised of 1.4 million people living in 14,000 square miles. Boundaries are from I-95 East to the coast, and from the Virginia line down to and including Onslow County. The area is largely rural and largely poor, with higher than state or national average rates for poverty and uninsured. Health status indicators show increased incidence of disease in the region, especially cancer, heart disease and stroke. VH determines priorities for target populations by working in concert with medical and community agency partners in ongoing assessment of the most pressing health care needs. Many efforts over the past decade have focused on diabetes, pediatric asthma, school health, injury prevention, access to care, nutrition enhancement, physical activities and chronic disease screenings. Also, special programs to manage the care of Medicaid enrollees, address access to both medical care and medications for the uninsured, and coordination of services for children with obesity have been undertaken. The populations that are served by addressing these issues are largely the poor, the underserved, and minorities. Determination of specific populations to address occurs when partners such as the North Carolina Department of Health and Human Services, local health departments, county Healthy Carolinian task forces, and physicians identify a quantifiable need, and community partners are engaged to work together with the health system. 2. Funding for community health programs is obtained from both the operating funds of VH entities and external grant-awarding organizations. The VH Board annually provides financial support for the Community Benefit Initiatives program of its foundation. These funds are then awarded to community agencies that successfully demonstrate both need and a well-designed plan to address one of the Foundation's priority categories. In addition, each VH hospital financially supports community health resources within its operating budget. Programs vary according to the hospital's financial ability and community need, but all include collaborative efforts with local health departments, including health screenings and education to targeted populations. VH also has a successful track record of obtaining community health program support from external agencies that award grant funding to approve projects. The VH Grants Office was established in 2008 and serves as the central point for grant mining, acquisition and management of grants awarded to VH hospitals for community-based programs. Grant funds are utilized to demonstrate the Effectiveness of a proposed community program, measure the outcomes achieved, and garner long-term sustainability from either the health system, other community agencies or as a collaborative program. Many community health programs are collaborative in nature with local service agencies, and often a portion of the grant funds are used to support resources or Services in these agencies. 3. Community health priorities are determined following a comprehensive review of community member feedback and secondary health data. Community alliances, partners and organizations, including local health departments, participate in this review. A list of the most pressing health issues are compiled for each community and then prioritized following an assessment of current health resources to address the identified health issues. Established resources/coalitions and new partnerships are formed to address the identified health priorities. 4. Community priorities are also established in response to a compelling need identified by health practitioners or community groups. VH is fortunate to have a strong collaborative partnership with East Carolina University, and works closely with the schools within the Health Sciences Division, especially the Brody School of Medicine. BSOM is an active participant in almost every community health initiative, supporting the research and evaluation of these programs, and contributes to programs for the under and uninsured in multiple ways. ECU and other educational institutions whose students matriculate through VH facilities also provide opportunities for collaboration and participation in various community health initiatives.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Continued:</FormAndLineReferenceDesc>
        <ExplanationTxt>5. Provided below are a few highlights of the community benefit and education activities: 5a. Community Health Improvement Services: Community health improvement services are programs and services that meet an identified need and are offered to the community at little or no charge. VH hospitals sponsor programs that improve access to health care for the underserved and enhance the identification and management of chronic diseases, such as cancer, diabetes and heart disease. Here are a few examples of these programs: - Medical assistance programs for uninsured patients - Support for Healthy Community Coalitions, including Healthy Carolinians of the Outer Banks. - Support of local Federally Qualified Health Center - Support for Healthy Neighbors faith health partnership - Support for school health partnerships 5b. Health Professional Education: Preparing future health care professionals is important to us. Our hospitals provide clinical settings for students of health professions, such as future physicians, nurses and other allied health professionals. We also support students through deferred forgivable loans and internships including resident training, nursing clinic sites, allied health professionals, and financial support of nursing programs. 5c. Research: East Carolina University (ECU) conducts research to evaluate new treatments and protocols. These studies help health professionals everywhere provide quality care to patients. VH supports this through various means including supporting the Institutional Review Board at ECU and providing study sites. 5d. Financial and In-Kind Contributions: VH donates money and in-kind services to community groups and activities that share our mission of improving health. They include Meals on Wheels, American Red Cross blood drives, medical supplies to emergency medical services, and free medications to qualifying patients. VH hospitals are key partners in fundraising for organizations such as the United Way, American Heart Association, Juvenile Diabetes Association and the American Cancer Society. VH contributed $800k to the Community Benefits Grants Program which awards grants to local non-profits for health related programs. 5e. Community Building: Community-building activities include programs that are not directly related to health care but address underlying issues that impact the health of communities. Poverty, crime, homelessness, workforce development and economic development all affect the overall health of communities. VH has provided support for our local Chambers of Commerce, financial support for road improvements, investments in communication infrastructure via information technology connections, support for the Teen Leadership Academy, recruitment of physicians to our rural communities, and programs that encourage students to pursue health careers.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The 990 is made available to Board Members by posting to a Board Member's website. Any Board Member who does not have the ability to access the return in this manner will receive a copy via electronic or regular mail. The return is also reviewed by the Chief Financial Officer, Chief General Counsel and the Chief Audit and Compliance Officer of University Health Systems prior to filing with the Internal Revenue Service.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>All Officers, Board Members and Key Employees are required to complete a yearly comprehensive conflict of interest questionnaire. These are reviewed by legal counsel and any potential or actual conflicts are brought to the Board for disposition. Board Members are instructed to report any potential conflicts arising during the year for review. Board Members are required to recuse themselves from voting on issues in which they are deemed to have a conflict.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The compensation is determined by the Compensation and Benefits Committee of the VH Board using comparative data from like organizations and input from consultants. This process is performed every year. Compensation of other officers and key employees is also determined by the Compensation and Benefits Committee of the VH Board using comparative data from like organizations and input from consultants. This process is performed every year. All compensation discussions and actions are documented and approved in the minutes of the Committee.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request for the same period of disclosure as set forth in IRC Section 6104(d).</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Net Asset Transfer 56,802,000. Capital Contributed to Coastal Plains Network 3,948,813.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, Line 2C</FormAndLineReferenceDesc>
        <ExplanationTxt>The process has not changed from the prior year.</ExplanationTxt>
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