STATE UNIVERSITY OF IOWA, UNIVERSITY OF IOWA HOSPITALS AND CLINICS. Financial Statements. June 30, 2016 and 2015

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1 Financial Statements (With Independent Auditors Report Thereon)

2 KPMG LLP 2500 Ruan Center 666 Grand Avenue Des Moines, IA Independent Auditors Report The Board of Regents State of Iowa: We have audited the accompanying financial statements of the State University of Iowa, University of Iowa Hospitals and Clinics (UIHC), which comprise the statements of net position as of, and the related statements of revenue, expenses, and changes in net position, and cash flows for the years then ended, and the related notes to the financial statements. Management s Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with U.S. generally accepted accounting principles; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error. Auditors Responsibility Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditors judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity s preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity s internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. Opinion In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of the State University of Iowa, University of Iowa Hospitals and Clinics as of June 30, 2016 and 2015, and the results of its operations and its cash flows for the years then ended, in accordance with U.S. generally accepted accounting principles. KPMG LLP is a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity.

3 Emphasis of Matters As discussed in note 1 to the financial statements, the financial statements of UIHC are intended to present the financial position and the changes in financial position and cash flows of only that portion of the business-type activities of the State University of Iowa that is attributable to the transactions of UIHC. UIHC is a department of the State University of Iowa for financial reporting purposes. The financial statements of UIHC do not purport to, and do not, present fairly the financial position of the State University of Iowa as of June 30, 2016 and 2015, the changes in its financial position and its cash flows for the years then ended, in conformity with U.S. generally accepted accounting principles. Our opinion is not modified with respect to this matter. Other Matters Required Supplementary Information U.S. generally accepted accounting principles require that the management s discussion and analysis on pages 3 8 and the schedules of proportionate share in net pension liability and UIHC contributions on pages be presented to supplement the basic financial statements. Such information, although not a part of the basic financial statements, is required by the Governmental Accounting Standards Board who considers it to be an essential part of financial reporting for placing the basic financial statements in an appropriate operational, economic, or historical context. We have applied certain limited procedures to the required supplementary information in accordance with auditing standards generally accepted in the United States of America, which consisted of inquires of management about the methods of preparing the information and comparing the information for consistency with management s responses to our inquiries, the basic financial statements, and other knowledge we obtained during our audit of the basic financial statements. We do not express an opinion or provide any assurance on the information because the limited procedures do not provide us with sufficient evidence to express an opinion or provide any assurance. Des Moines, Iowa November 23,

4 Management s Discussion and Analysis Introduction This Section of the State University of Iowa, University of Iowa Hospitals and Clinics (UIHC) annual financial report presents management s discussion and analysis of UIHC s financial performance during the years ended. The purpose is to provide an objective analysis of the financial activities of UIHC based on currently known facts, decisions, and conditions. Please read it in conjunction with UIHC s financial statements and the accompanying notes to the financial statements. Financial Highlights UIHC demonstrated financial success in 2016 with an increase in net position of $75.9 million or 6.0%, as compared to an increase in net position in 2015 by $37.4 million, or 3.0%. Operating income in 2016 was $101.2 million, an increase of $17.1 million when compared to Nonoperating revenue, net increased $6.5 million driven mainly by investment performance. Operating income in 2015 was $84.1 million, an increase of $29.5 million when compared to Nonoperating revenue, net decreased $45.0 million. Overview of the Financial Statements This annual report consists of two parts management s discussion and analysis and the basic financial statements. The financial statements consist of three statements statements of net position; statements of revenue, expenses, and changes in net position; and statements of cash flows. These financial statements and related notes provide information about the activities of UIHC and have been prepared on an accrual basis in accordance with Governmental Accounting Standards Board (GASB) accounting principles. In July 2014, UIHC adopted GASB 68, Accounting and Financial Reporting for Pensions An Amendment of GASB Statement No. 27 and GASB Statement No. 71, Pension Transition for Contributions Made Subsequent to the Measurement Date An Amendment of GASB Statement No. 68. The adoption of GASB 68 required UIHC to record its proportionate share of pension liability related to its employees participation in Iowa Public Employee Retirement System (IPERS). As a result, beginning net position as of July 1, 2014 was restated by $16.8 million. Statements of Net Position and Statements of Revenue, Expenses, and Changes in Net Position In 2016, net position increased by $75.9 million or approximately 6.0%, to $1.34 billion. This is primarily due to net income from operations of $101.2 million. In 2015, net position increased by $37.4 million or approximately 3.0%, to $1.26 billion. This is primarily due to net income from operations of $84.1 million. 3 (Continued)

5 Management s Discussion and Analysis Table 1 provides a summary of UIHC s assets, deferred outflows, liabilities, deferred inflows, and net position as of June 30, 2016, 2015, and Table 1 Condensed Statements of Net Position (In thousands) Assets and Deferred Outflows Current assets $ 349, , ,641 Noncurrent cash and investments 658, , ,728 Capital assets, net 973, , ,136 Other assets 1,356 1,013 1,020 Total assets 1,983,607 1,902,717 1,850,525 Deferred outflows 13,748 6, Total assets and deferred outflows $ 1,997,355 1,908,822 1,850,977 Liabilities, Deferred Inflows, and Net Position Current liabilities $ 223, , ,848 Long-term debt 343, , ,579 Other long-term liabilities 89,272 69,827 43,009 Total liabilities 656, , ,436 Deferred inflows 1,959 5, Net position: Net investment in capital assets 620, , ,748 Restricted 6,771 5,633 7,571 Unrestricted 711, , ,206 Total net position 1,338,814 1,262,900 1,225,525 Total liabilities, deferred inflows, and net position $ 1,997,355 1,908,822 1,850,977 4 (Continued)

6 Management s Discussion and Analysis Table 2 shows the changes in net position for 2016 compared to 2015 and Table 2 Statements of Revenue, Expenses, and Changes in Net Position (In thousands) Operating revenue: Net patient service revenue $ 1,410,009 1,261,432 1,139,952 Other revenue 46,656 52,835 49,580 Total operating revenue 1,456,665 1,314,267 1,189,532 Operating expenses: Salaries and benefits 655, , ,736 Medical supplies and drugs 323, , ,318 Other supplies and general expenses 298, , ,250 Depreciation and amortization 78,993 74,712 73,640 Total operating expenses 1,355,508 1,230,182 1,134,944 Operating income 101,157 84,085 54,588 Nonoperating revenue (expenses): Gain (loss) on disposal of capital assets (2,818) 212 (2,986) Noncapital gifts Investment income 15,669 7,563 56,837 Interest expense (6,054) (7,490) (8,607) Total nonoperating revenue, net 6, ,294 Excess of revenue over expenses before transfers 107,956 84,372 99,882 Capital gifts and grants Net transfers out (32,042) (30,415) (42,331) Increase in net position 75,914 54,120 57,851 Net position, beginning of year 1,262,900 1,208,780 1,167,674 Net position, end of year $ 1,338,814 1,262,900 1,225,525 5 (Continued)

7 Management s Discussion and Analysis Net Patient Service Revenue Net patient service revenue increased from 2015 to 2016 by $148.6 million, or 11.8%, and $121.5 million, or 10.7%, from 2014 to The increases in net patient service revenue were driven by both increases in patient volumes and pricing increases during the same periods. The increase in 2016 resulted from increases in both inpatient and outpatient areas. There was an increase in outpatient clinic visits from 2015 to 2016 by 49,792, or 5.6%, with a decrease in outpatient surgeries of (1,675) or (9.5%). On the inpatient side, acute admissions were up 1,369, or 4.3%, over 2015 and inpatient surgeries increased by 2,594, or 21.0%. The increase in 2015 resulted from increases in both inpatient and outpatient areas. There was an increase in outpatient clinic visits from 2014 to 2015 by 33,162, or 3.9%, and an increase in outpatient surgeries of 778, or 2.7%. On the inpatient side, acute admissions were up 1,118, or 3.6%, over 2014 and inpatient surgeries increased by 769, or 6.6%. The provision for bad debts (a deduction from gross patient charges) increased $16.6 million from $15.8 million in 2015 to $32.4 million in The provision for bad debts (a deduction from gross patient charges) decreased $35.1 million from $50.9 million in 2014 to $15.8 million in The increase in the provision for bad debts in 2016 puts our bad debts in line with our historical annual amounts. The increase in 2016 compared to 2015 was due to the large decrease in the provision for bad debts in The large decrease in 2015 was caused by a significant shift in payor mix from self-pay to other insurers. Operating Expenses Total operating expenses increased 10.2% from $1.23 billion in 2015 to $1.36 billion in The largest dollar increase in expenses in 2016 was in medical supplies and drugs, which increased $40.5 million, or 14.3%, when compared to In 2016, there was a continued effort to expand the outpatient pharmacy specialty drug program, which along with increased volumes and inflation, increased drug expense. Total operating expenses increased 8.4% from $1.13 billion in 2014 to $1.23 billion in The largest dollar increase in expenses in 2015 was in medical supplies and drugs, which increased $35.4 million, or 14.3%, when compared to In 2015, there was a continued effort to expand the outpatient pharmacy specialty drug program, which along with increased volumes and inflation, increased drug expense. Nonoperating Revenue and Expenses, Net Nonoperating revenue consists primarily of gains (losses) on disposals of capital assets, investment income, interest expense, and noncapital gifts. Investment income increased from 2015 to 2016 by $8.1 million, or 107.2%, and decreased from 2014 to 2015 by $49.3 million, or 86.7%. During 2016, UIHC recorded overall earnings on the endowment and operating pools of $9.3 million and a net unrealized gain on investments of $6.3 million, which increased investment income accordingly. This compares to the overall earnings on the endowment and operating pools of $27.4 million and a net unrealized loss on investments of $19.9 million in the previous year. The increases in these investments follow overall investment markets. 6 (Continued)

8 Management s Discussion and Analysis Statements of Cash Flows The statements of cash flows reports cash receipts, cash payments, and net changes in cash resulting from operating, investing, and financing activities. UIHC s overall liquidity increased during 2016, with a net increase in cash and cash equivalents of $2.7 million. In 2016, net cash from operating activities provided cash inflows of $221.4 million and net cash used in noncapital financing was $32.0 million. UIHC s overall liquidity decreased during 2015, with a net decrease in cash and cash equivalents of $5.6 million. In 2015, net cash from operating activities provided cash inflows of $102.4 million and net cash used in noncapital financing was $30.4 million. Capital Assets and Debt Administration Capital Assets At the end of 2016, UIHC had $973.9 million invested in capital assets, net of accumulated depreciation. This is a $153.2 million increase when compared to capital assets, net in 2015 of $820.7 million. This increase is primarily due to the UIHC Children s Hospital. Capital assets, net of accumulated depreciation increased to $820.7 million in 2015 compared to capital assets, net in 2014 of $699.1 million. This increase is primarily due to the UIHC Children s Hospital. The major capital asset additions in 2015 and 2016 included the following: Stead Family Children s Hospital Pediatric specialty clinic expansion and conference center development Main operating room expansion Pediatric cardiac catheterization laboratory relocation and expansion Ambulatory surgery center operating room expansion Emergency generators supporting John Pappajohn Pavilion, Children s Hospital and Hospital Ramp 2 Debt Levels 7 and 8 John Colloton Pavilion and John Pappajohn Pavilion rooftop infills University of Iowa Health Care Support Services Building interior construction and equipment Boyd Tower relocation of Pediatric and Psychiatry departmental offices At, UIHC had $353.6 million and $369.6 million, respectively, in bonds and capital lease outstanding. During 2016 and 2015, payments of long-term debt were $74.0 million and $13.3 million, respectively. During 2016, UIHC issued $29 million of Series S.U.I Hospital Revenue Refunding Bonds and $23.86 million of Series S.U.I. 2016A Hospital Revenue Refunding Bonds. The proceeds of the bonds were used by UIHC to refund the Series S.U.I Hospital Revenue Bonds, Series S.U.I. 2007A Hospital Revenue Bonds, and Series S.U.I Hospital Revenue Bonds. During 2015, UIHC issued no Hospital Revenue Bonds. 7 (Continued)

9 Management s Discussion and Analysis Contacting UIHC s Financial Management This financial report provides the citizens of Iowa, UIHC patients, bondholders, and creditors with a general overview of UIHC s finances and operations. If you have questions about this report, please contact Mr. Kenneth L. Fisher, Associate Vice President for Finance, UI Healthcare and CFO, University of Iowa Hospitals and Clinics, 318 CMAB, Iowa City, Iowa

10 Statements of Net Position (In thousands) Assets and Deferred Outflows Current assets: Cash and cash equivalents $ 16,101 13,383 Short-term investments 75,435 51,886 Patient accounts receivable, net of estimated uncollectibles $18,216 in 2016 and $21,116 in , ,775 Inventories 27,615 23,698 Current investments for debt service restricted 1,230 1,296 Other current assets 18,712 16,199 Total current assets 349, ,237 Noncurrent cash and investments: Limited by bond resolutions 25,123 62,224 Designated by the Board of Regents 627, ,971 Restricted by donors 5,850 4, , ,817 Capital assets, net 973, ,650 Other assets 1,356 1,013 Total assets 1,983,607 1,902,717 Deferred outflow of resources: Deferred outflows 13,748 6,105 Total assets and deferred outflows $ 1,997,355 1,908,822 Liabilities, Deferred Inflows, and Net Position Current liabilities: Current maturities of long-term debt $ 9,842 13,416 Accounts payable and accrued expenses 141, ,878 Estimated third-party payor settlements 44,735 51,752 Due to related parties 16,900 9,740 Other current liabilities 6,457 5,393 Accrued interest 3,803 4,776 Total current liabilities 223, ,955 Long-term debt, net of current maturities 343, ,212 Other long-term liabilities 89,272 69,827 Total liabilities 656, ,994 Deferred inflow of resources: Deferred inflows 1,959 5,928 Net position: Net investment in capital assets 620, ,161 Restricted by donors for specific purposes 5,541 4,337 Restricted for debt service 1,230 1,296 Unrestricted 711, ,106 Total net position 1,338,814 1,262,900 Total liabilities, deferred inflows, and net position $ 1,997,355 1,908,822 See accompanying notes to financial statements. 9

11 Statements of Revenue, Expenses, and Changes in Net Position Years ended (In thousands) Operating revenue: Net patient service revenue, net of provision for bad debts of $32,399 in 2016 and $15,831 in 2015 $ 1,410,009 1,261,432 Other revenue 46,656 52,835 Total operating revenue 1,456,665 1,314,267 Operating expenses: Salaries and benefits 655, ,713 Medical supplies and drugs 323, ,719 Other supplies and general expenses 298, ,038 Depreciation and amortization 78,993 74,712 Total operating expenses 1,355,508 1,230,182 Operating income 101,157 84,085 Nonoperating revenue (expenses): Gain (loss) on disposal of capital assets (2,818) 212 Noncapital gifts 2 2 Investment income 15,669 7,563 Interest expense (6,054) (7,490) Total nonoperating revenue, net 6, Excess of revenue over expenses before transfers 107,956 84,372 Capital gifts and grants 163 Net transfers out (32,042) (30,415) Increase in net position 75,914 54,120 Net position, beginning of year 1,262,900 1,208,780 Net position, end of year $ 1,338,814 1,262,900 See accompanying notes to financial statements. 10

12 Statements of Cash Flows Years ended (In thousands) Cash flows from operating activities: Receipts from and on behalf of patients $ 1,429,043 1,197,937 Other receipts 53,816 47,793 Payments to employees (626,583) (582,819) Payments to suppliers and contractors (634,845) (560,505) Net cash provided by operating activities 221, ,406 Cash flows from noncapital financing activities: Net transfers (32,042) (30,415) Noncapital gifts 2 2 Net cash used in noncapital financing activities (32,040) (30,413) Cash flows from capital and related financing activities: Purchase of capital assets (232,202) (197,200) Proceeds from the sale of capital assets Capital gifts and grants received 163 Proceeds from the issuance of long-term debt 52,860 Premium received on the issuance of long-term debt 6,495 Principal paid on long-term debt (73,965) (13,350) Interest paid on long-term debt (8,406) (8,605) Net cash used in capital and related financing activities (255,209) (218,018) Cash flows from investing activities: Proceeds from sale of investments 246, ,542 Purchase of investments (187,064) (311,623) Interest and dividends received on investments 9,358 27,493 Net cash provided by investing activities 68, ,412 Net (decrease) increase in cash and cash equivalents 2,718 (5,613) Cash and cash equivalents at beginning of year 13,383 18,996 Cash and cash equivalents at end of year $ 16,101 13,383 Reconciliation of operating income to net cash provided by operating activities: Operating income $ 101,157 84,085 Adjustments to reconcile operating income to net cash provided by operating activities: Depreciation and amortization 78,993 74,712 Provision for bad debts 32,399 15,831 Changes in assets and liabilities: Accounts receivable (6,348) (75,911) Inventories (3,917) (4,432) Other assets (10,434) (10,069) Accounts payable and accrued expenses 12,898 10,861 Other liabilities 16,540 15,786 Due to/from related parties 7,160 (5,042) Estimated third-party payor settlements (7,017) (3,415) Net cash provided by operating activities $ 221, ,406 Noncash investing activity: During 2016 and 2015, the net appreciation (depreciation) in fair value of investments was $6,346 and $(19,860), respectively. See accompanying notes to financial statements. 11

13 (1) Summary of Significant Accounting Policies and Related Matters (a) Reporting Entity For purposes of this report, the State University of Iowa, University of Iowa Hospitals and Clinics (UIHC) includes the healthcare units of the State University of Iowa (the University), which are generally referred to as the University Hospital, the Psychiatric Hospital, and the Center for Disabilities and Development. UIHC is part of the University, which is a component unit of the state of Iowa and operated under the supervision of the Board of Regents, state of Iowa (the Board). UIHC is a University department for financial reporting purposes. UIHC includes substantially all of the healthcare provider activities for patient care associated with the University other than the physician and dentist services and research activities provided by the faculties of the University s Colleges of Medicine and Dentistry. Student Health Services, Specialized Child Health Services outreach programs, and the University of Iowa Health System (UIHS), a UIHC affiliate, are not included in these financial statements. UIHC is a comprehensive tertiary care referral center located in Iowa City, Iowa, offering a full range of clinical services in substantially all specialties and subspecialties of medicine and dentistry. UIHC serves as a resource for the state s primary and secondary healthcare providers. Patients are primarily from Iowa. (b) Basis of Presentation UIHC s financial statements have been prepared using the economic resources measurement focus and the accrual basis of accounting. Under this method, revenue is recorded when earned and expenses are recorded at the time liabilities are incurred without regard to receipt or disbursement of cash. (c) Use of Estimates The preparation of financial statements in conformity with U.S. generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. Actual results could differ from those estimates. (d) Cash and Investments Cash and investments of UIHC include specific investments and other cash and investments that are pooled with the cash and investments of the University and held in the name of the University. UIHC s share of pooled investments and income thereon is determined on a pro rata basis reflecting UIHC s amounts available for investment as compared with the amounts for the overall University. For purposes of the Statement of Net Position and Statement of Cash Flows, cash and cash equivalents are reported in accordance with Board of Regents, State of Iowa policy Chapter 2., section 4.C.ix 12 (Continued)

14 ( estment%20policy), which states in part: to appropriately reflect the Board s overall investment strategy and as outlined in the GASB Statement No. 9 Reporting Cash Flows of Proprietary and Nonexpendable Trust Funds and Governmental Entities that Use Proprietary Fund Accounting, (paragraph 11), that all funds held by external investment managers, as defined in section C.iv of the Board s investment policy, shall be reported on the audited financial statements of the Regent institutions as investments. Investments purchased by the institutions through Board authorized brokerage firms that meet the definition of cash equivalents, investment with original purchase dates to maturity of three months or less shall be reported on the audited financial statements of the Regent institutions as cash equivalents. Investments are reported at fair value except for certain investments maintained in shorter term investments such as money market funds which are accounted for at amortized cost. Changes in unrealized gain (loss) on the carrying value of the investments are reported as a component of investment income in the Statements of Revenue, Expenses, and Changes in Net Position. Please see note 2 for further discussion. Undesignated cash equivalents totaling $16.1 million and $13.4 million at, respectively, represent money market funds and other short-term investments not held by external investment managers that mature in three months or less from date of purchase. (e) Inventories Inventories consist primarily of medical and surgical, pharmaceutical, dietary, and other supplies. Inventories are stated at the lower of cost or market, with cost determined on the first-in, first-out or weighted average basis. (f) Capital Assets UIHC s capital assets are reported at historical cost. Contributed capital assets are reported at their estimated fair value at the time of their donation. All capital assets other than land are depreciated or amortized using the straight-line method of depreciation using the following asset lives: Buildings and leasehold improvements Infrastructure and land improvements Equipment and software 10 to 40 years 5 to 20 years 3 to 10 years (g) Deferred Outflows and Inflows of Resources Deferred outflows of resources represent consumptions of net position that apply to future periods and will not be recognized as an outflow of resources (expense) until then. Deferred inflows of resources represent acquisitions of net position that apply to future periods and will not be recognized as an inflow of resources (revenue) until then. 13 (Continued)

15 (h) Costs of Borrowing Except for capital assets acquired through gifts, contributions, or capital grants, interest cost on borrowed funds during the period of construction of capital assets is capitalized as a component of the cost of acquiring those assets. Interest costs capitalized for the years ended were $6.3 million and $6.2 million, respectively. (i) Gifts and Grants From time to time, UIHC receives grants, as well as gifts from individuals and private organizations. Gifts and grants may be restricted either for specific operating purposes or for capital purposes. (j) Restricted Resources When UIHC has both restricted and unrestricted resources available to finance a particular program, it is UIHC s policy to use restricted resources before unrestricted resources. (k) Net Position Net position of UIHC is classified in four components. Net investment in capital assets consists of capital assets net of accumulated depreciation and reduced by the balances of any outstanding borrowings used to finance the purchase or construction of those assets. Net position restricted by donors for specific purposes is noncapital net position that must be used for a particular purpose, as specified by grantors, or contributors external to UIHC. Net position restricted for debt service is amounts deposited with trustees as required by bond indentures. Unrestricted net position is remaining net position that does not meet the definition of net investment in capital assets or restricted. (l) Operating Revenue and Expenses UIHC s statements of revenue, expenses, and changes in net position distinguish between operating and nonoperating revenue and expenses. Operating revenue result from exchange transactions associated with providing healthcare services UIHC s principal activity. Nonexchange revenue, including investment income and gifts received for purposes other than capital asset acquisition, are reported as nonoperating revenue. Operating expenses are all expenses incurred to provide healthcare services, other than financing costs. (m) Net Patient Service Revenue UIHC has agreements with third-party payors that provide for payments to UIHC at amounts different from its established rates. Payment arrangements include prospectively determined rates per discharge, reimbursed costs, discounted charges, and per diem payments. Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payors, and others for services rendered, including estimated retroactive adjustments under reimbursement agreements with third-party payors and estimated uncollectible amounts. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements are determined. 14 (Continued)

16 (n) Charity Care UIHC provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because UIHC does not pursue collection of amounts once determined to qualify as charity care, they are not reported as revenue in the accompanying statements of revenue, expenses, and changes in net position. (o) Compensated Absences UIHC employees accumulate vacation and sick leave under the provisions of the Code of Iowa. Under the state s policy, accrued vacation benefits are paid at an employee s regular hourly rate when used or are paid upon retirement, death, or termination with certain exceptions. Sick leave is paid in a similar manner when used or to a maximum of $2,000 upon retirement. These benefits are accrued in the financial statements as earned by UIHC employees. (p) Pension Iowa Public Employees Retirement System For purposes of measuring the net pension liabilities, deferred outflows of resources and deferred inflows of resources, and pension expense, information about the fiduciary net position of the Iowa Public Employees Retirement System (IPERS) and additions to/deductions from IPERS fiduciary net position have been determined on the same basis as they are reported by IPERS. For this purpose, benefit payments (including refunds of employee contributions) are recognized when due and payable in accordance with benefit terms. Investments are reported at fair value. (q) Income Taxes UIHC, as part of the University, is exempt from federal income taxes, pursuant to Section 115 of the Internal Revenue Code. As such, UIHC is subject to income taxes only on unrelated business income under the provisions of Section 511 of the Internal Revenue Code. (r) Adoption of New Accounting Standard During 2016, the UIHC adopted GASB Statement No. 72, Fair Value Measurement and Application. This Statement addresses accounting and financial reporting issues related to fair value measurements. Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. This Statement provides guidance for determining a fair value measurement for financial reporting purposes. This Statement also provides guidance for applying fair value to certain investment and disclosures related to all fair value measurements. The adoption of this Statement had no effect on net position or on revenue or expenses. (s) Reclassifications Certain reclassifications were made to 2015 balances to conform to 2016 presentation. The reclassifications had no impact on net position or excess of revenue over expenses. 15 (Continued)

17 (2) Deposits and Investments Investments are made in accordance with Chapter 12B.10 of the Code of Iowa, and Board of Regents, State of Iowa policy ( t Policy). UIHC s cash and investments include specific investments and amounts pooled with cash and investments of the University and held in the University s name. Noncurrent cash and investments limited by bond resolutions or designated by the Board were held for the following purposes at : Limited by bond resolutions: Debt service reserve $ 25,123 27,080 Unspent bond proceeds 35,144 Designated by the Board of Regents: Capital projects and equipment and other needs 389, ,082 Surplus 579 1,096 Improvement, extension, repair, operation, and maintenance funds 237, ,793 Restricted by donors 5,850 4,622 $ 658, ,817 Funds for improvement, extension, repair, operation, and maintenance shall be used to pay costs of operating and maintaining the hospital system whenever other funds are not sufficient and for improvements, extensions, and repairs. Noncurrent cash and investments include designated assets set aside by the Board for future facility infrastructure improvements, equipment, and technological needs, over which UIHC retains control and may, at its discretion, subsequently authorize its use for other purposes. The funds are invested in investment pools with allocations to equities, fixed income, real assets, and liquidity asset classes. Cash and cash equivalents and short-term investments specifically identified or pooled with the cash and investments of the University totaled $91.5 million and $65.3 million at, respectively. Cash equivalents designated by the Board totaled $173.7 million and $233.7 million at, respectively. 16 (Continued)

18 UIHC s investments are recorded at fair value. As of June 30, 2016, UIHC had the following investments and quality credit ratings (in thousands): Effective Total duration TSY/AGY market Fixed income (years) AAA AA A BBB BB B N/A value Corporate notes and bonds 1.48 $ ,494 1, ,862 U.S. government agencies ,856 22,026 U.S. Treasury obligations ,355 19,355 Mutual funds ,806 13,832 52,583 38,561 41, ,627 $ ,338 15,326 53,828 38,636 41, ,870 Other investments: Cash and cash equivalents 265,182 U.S. equity mutual funds 50,120 Non-U.S. equity mutual funds 41,918 Real assets 97,500 Private equity 7,760 Total cash and investments $ 751,350 UIHC s investments are recorded at fair value. As of June 30, 2015, UIHC had the following investments and quality credit ratings (in thousands): Effective Total duration TSY/AGY market Fixed income (years) AAA AA A BBB BB B N/A value Corporate notes and bonds 1.63 $ 1, ,087 1, ,621 U.S. government agencies , ,869 U.S. Treasury obligations ,570 27,570 Mutual funds ,680 14,659 33,174 21,174 64, ,941 $ 49,966 79,464 16,746 34,368 21,203 64, ,001 Other investments: Cash and cash equivalents 298,957 U.S. equity mutual funds 54,375 Non-U.S. equity mutual funds 49,772 Real assets 85,093 Private equity 5,380 Repurchase agreement 44,804 Total cash and investments $ 804, (Continued)

19 (a) Interest Rate Risk Interest rate risk is the risk changes in interest rates will adversely affect the fair value of an investment. This risk is measured using effective duration. At time of purchase, the effective maturity of direct investment purchases by the University in the operating portfolio cannot exceed sixty-three months. There is no explicit limit on the average maturity of fixed income securities in the endowment portfolios. Each fixed income portfolio is managed to an appropriate benchmark. (b) Credit Risk Credit risk is the risk that an issuer or other counterparty to an investment will not fulfill its obligation to the University. The University manages exposure to credit risk by measuring portfolios against benchmarks as established by the Board of Regents. As of June 30, 2016, the University s long-term bond funds benchmark is AA (Barclays Capital Aggregate Bond Index). (c) Concentration of Credit Risk Concentration of credit risk is the risk of loss attributed to the magnitude of investments in a single issuer. Except for Treasury or Agency debentures, pass-throughs, or REMICs, no more than 5% of University investment portfolios are invested in securities of a single issuer. All direct investment purchases by the University in the operating portfolio are U.S. Treasury and Agency securities. (d) Fair Value Measurements Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Generally accepted accounting principles provide a hierarchy that prioritizes the inputs to fair value measurements based on the extent inputs to valuation techniques are observable in the marketplace. The hierarchy assigns a higher priority to observable inputs that would reflect UIHC s assumptions about how market participants would value an asset or liability based on the best information available. Fair value measurements should maximize the use of observable inputs and minimize the use of the unobservable inputs. The three levels of the fair value hierarchy are as follows: Level 1 Unadjusted quoted prices in active markets for identical assets or liabilities that are available at the measurement date. Level 2 Inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly or indirectly. Level 3 Unobservable inputs for the asset or liability that are used to measure fair value when observable inputs are not available. These inputs are developed based upon the best information available in such circumstances. The categorization of fair value measurements by level of the hierarchy is based upon the lowest level input that is significant to the overall fair value measurement for a given asset or liability. In the event that changes in the inputs used in the fair value measurement of an asset or liability result in a transfer into a different level, such transfers are recognized at the end of the reporting period. 18 (Continued)

20 UIHC receives prices from custodians who use third-party pricing services to price portfolios. When available, quoted priced are used to determine fair value. When quoted prices in active markets are available, investments are classified within Level 1. For certain fixed income securities, pricing usually includes matrix pricing which includes modeling from observable market inputs in active markets. Typical inputs include benchmark yields, reported trades, broker-dealer quotes, issuer spreads, and benchmark securities, among others. These investments are classified as Level 2 within the fair value hierarchy. Certain UIHC investments that do not have a readily determinable fair value are reported using Net Asset Value per share (NAV). Used as a practical expedient for the estimated fair value, NAV per share or its equivalent is provided by the fund manager and reviewed by UIHC. Investment holdings using the NAV as a practical expedient consist of UIHC interests in funds investing in nonmarketable private equity and real assets, as well as indirect holdings of publicly traded assets in fixed income and international equity commingled funds. These investments at NAV are not classified in the fair value hierarchy. Due to the nature of the investments held by the funds, changes in market conditions, economic environment, regulatory environment, currency exchange rates, interest rates, and commodity price fluctuations may significantly impact the NAV of the funds, and consequently, the fair value of UIHC s interest in the funds and could materially affect the amounts reported in the consolidated financial statements. UIHC attempts to manage these risks through diversification, ongoing due diligence of fund managers, maintaining adequate liquidity, and continuously monitoring economic and market conditions. 19 (Continued)

21 The following table reflects fair value measurements of investment assets at June 30, 2016 as categorized by level of the fair value hierarchy according to the lowest level of inputs significant to each measurement of NAV (in thousands): 2016 Level 1 Level 2 Level 3 NAV Total Fixed income: Corporate notes and bonds $ 3,862 3,862 U.S. government agencies 22,026 22,026 U.S. Treasury obligations 19,355 19,355 Mutual funds 174,932 68, ,627 U.S. equity 50,120 50,120 Non-U.S. equity 15,698 26,220 41,918 Real assets 86,692 10,808 97,500 Private equity 7,760 7,760 $ 346,797 25, , ,168 Bank investments 88,758 Money market/cash equivalents 176,424 Total cash and investments $ 751,350 The following tables summarize UIHC's investments at June 30, 2016 for which NAV was used as a practical expedient to estimate fair value. Fair value Unfunded determined commitments using NAV at June 30, Redemption Redemption Asset class frequency notice period Fixed income mutual funds $ 68,695 daily monthly 5 30 days Non-U.S. equity 26,220 semimonthly monthly 2 30 days Real assets: Redeemable 4,615 quarterly 90 days Nonredeemable 6,194 N/A N/A Private equity: Redeemable Nonredeemable 7,759 N/A N/A Investment measured at NAV $ 113, (Continued)

22 The following table reflects fair value measurements of investment assets at June 30, 2015 as categorized by level of the fair value hierarchy according to the lowest level of inputs significant to each measurement of NAV (in thousands): 2015 Level 1 Level 2 Level 3 NAV Total Fixed income: Corporate notes and bonds $ 4,481 4,481 U.S. government agencies 21,798 21,798 U.S. Treasury obligations 27,428 27,428 Mutual funds 176,137 72, ,973 U.S. equity 53, ,558 Non-U.S. equity 18,704 30,226 48,930 Real assets 77,288 7,515 84,803 Private equity 5,180 5,180 Repurchase agreement 44,804 44,804 $ 353,002 71, , ,955 Bank investments 113,604 Money market/cash equivalents 150,823 Total cash and investments $ 804,382 The following table summarizes the University's investments at June 30, 2015 for which NAV was used as a practical expedient to estimate fair value. Fair value Unfunded determined commitments using NAV at June 30, Redemption Redemption Asset class frequency notice period Fixed income mutual funds $ 72,836 daily monthly 5 30 days Non-U.S. equity 30,226 semimonthly monthly 2 30 days Real assets: Redeemable 3,845 quarterly 90 days Nonredeemable 3,670 5,904 N/A N/A Private equity: Redeemable Nonredeemable 5,180 6,329 N/A N/A Investment measured at NAV $ 115,757 12, (Continued)

23 The following information is provided for investments that are valued using the NAV per share as a practical expedient: Fixed Income Mutual Funds This category includes investments in mutual funds holding assets that provide stability, generate income, and diversify market risk. Non-U.S. Equity Funds This category includes investments in international equities including both developed and emerging markets. Real Assets This category includes investments in private real estate and natural resource funds. Capital is committed during the course of the investment period, typically four years, of each fund, after which point capital commitments stop. UIHC s interest in the nonredeemable funds is considered to be illiquid in that distributions from liquidation of the underlying asset of the fund are at the discretion of the general partner per the terms of the limited partnership agreement. Funds are typically liquidated over a period of five to ten years, and include a mechanism to extend the length of the partnership with approval from the limited partners. Private Equity This category includes funds that invest in strategies such as venture capital, leveraged buyouts and mezzanine debt. Capital is committed during the course of the investment period, typically four years, of each fund, after which point capital commitments stop. UIHC s interest in the nonredeemable funds is considered to be illiquid in that distributions from liquidation of the underlying asset of the fund are at the discretion of the general partner per the terms of the limited partnership agreement. Funds are typically liquidated over a period of five to ten years, and include a mechanism to extend the length of the partnership with approval from the limited partners. (3) Capital Assets Capital assets at are summarized as follows (in thousands): Land $ 19,228 17,835 Land improvements 1, Infrastructure 55,123 54,686 Buildings and leasehold improvements 1,005, ,851 Equipment and software 486, ,450 Construction in progress (nondepreciable) 360, ,329 1,928,683 1,711,076 Less accumulated depreciation 954, ,426 $ 973, , (Continued)

24 Capital asset additions, retirements, and balances as of and for the years ended were as follows (in thousands): June 30, Sales June 30, 2015 retirements 2016 Cost basis summary balances Acquisitions and transfers balances Land (nondepreciable) $ 17,835 1,393 19,228 Land improvements ,138 Infrastructure 54, ,123 Buildings and leasehold improvements 944,851 60,832 (148) 1,005,535 Equipment and software 448,450 53,575 (15,364) 486,661 Construction in progress (nondepreciable) 244, ,291 (80,622) 360,998 Total at historical cost 1,711, ,741 (96,134) 1,928,683 Less accumulated depreciation for: Land improvements Infrastructure 42,751 1,640 44,391 Buildings and leasehold improvements 562,342 32,890 (114) 595,118 Equipment and software 284,540 44,441 (14,472) 314,509 Total accumulated depreciation 890,426 78,993 (14,586) 954,833 Total capital assets, net $ 820, ,748 (81,548) 973, (Continued)

25 June 30, Sales June 30, 2014 retirements 2015 Cost basis summary balances Acquisitions and transfers balances Land (nondepreciable) $ 15,609 2,226 17,835 Land improvements Infrastructure 48,999 5,687 54,686 Buildings and leasehold improvements 888,365 56,586 (100) 944,851 Equipment and software 409,833 54,256 (15,639) 448,450 Construction in progress (nondepreciable) 166, ,696 (82,463) 244,329 Total at historical cost 1,529, ,451 (98,202) 1,711,076 Less accumulated depreciation for: Land improvements Infrastructure 41,073 1,678 42,751 Buildings and leasehold improvements 532,075 30,367 (100) 562,342 Equipment and software 256,767 42,650 (14,877) 284,540 Total accumulated depreciation 830,691 74,712 (14,977) 890,426 Total capital assets, net $ 699, ,739 (83,225) 820,650 At June 30, 2016, construction in progress is related to various projects throughout the UIHC. The estimated cost to complete the current phase of equipment and projects under construction at June 30, 2016 is $129.6 million. Other projects at June 30, 2016, with an estimated cost of $284.0 million, have been committed to by the Board and/or UIHC; however, construction contracts had not been signed as of June 30, These projects are anticipated to be funded through existing designated funds, cash provided by future operations, and/or the issuance of additional long-term debt. 24 (Continued)

26 (4) Long-Term Debt Long-term debt outstanding at was as follows (in thousands): Hospital Revenue Bonds: Series S.U.I % to 5.500%; maturing serially on September 1 through 2027 $ 18,675 Series S.U.I. 2007A 4.000% to 5.500%; maturing serially on September 1 through ,850 Series S.U.I % to 6.125%; maturing serially on September 1 through ,525 Series S.U.I % to 4.500%; maturing serially on September 1 through ,850 27,675 Series S.U.I % to 4.000%; maturing serially on September 1 through ,875 24,875 Series S.U.I. 2011A 2.000% to 4.125%; maturing serially on September 1 through ,365 17,375 Series S.U.I % to 4.000%; maturing serially on September 1 through , ,925 Series S.U.I % to 5.000%; maturing serially on September 1 through ,000 Series S.U.I. 2016A 3.000% to 3.000%; maturing serially on September 1 through ,860 Net unamortized premium on Hospital Revenue Bonds 17,280 12,164 Telecommunications Facilities Revenue Bonds: Series S.U.I % to 3.375%; maturing serially on July 1 through Series S.U.I % to 4.250%; maturing serially on July 1 through ,453 11,804 Series S.U.I % to 4.500%; maturing serially on July 1 through ,717 7,005 Total long-term bonds 335, ,170 Capital lease obligation 18,489 19,458 Total long-term debt 353, ,628 Long-term debt, current portion 9,842 13,416 $ 343, , (Continued)

27 Activity in long-term debt for the years ended was as follows (in thousands): June 30, June 30, Amounts due within balance Additions Reductions balance one year Hospital Revenue Bonds, Series 2007 $ 18,675 (18,675) Hospital Revenue Bonds, Series 2007A 18,850 (18,850) Hospital Revenue Bonds, Series ,525 (26,525) Hospital Revenue Bonds, Series ,675 (825) 26, Hospital Revenue Bonds, Series ,875 (1,000) 23,875 1,025 Hospital Revenue Bonds, Series 2011A 17,375 (1,010) 16,365 1,040 Hospital Revenue Bonds, Series ,925 (5,175) 179,750 5,275 Hospital Revenue Bonds, Series ,000 29,000 Hospital Revenue Bonds, Series 2016A 23,860 23,860 Net unamortized bond premium 12,164 6,495 (1,379) 17,280 Telecommunications Facilities Revenue Bonds: Series (297) Series ,804 (351) 11, Series ,005 (288) 6, Total long-term bonds 350,170 59,355 (74,375) 335,150 8,844 Capital lease obligations 19,458 (969) 18, Total long-term debt $ 369,628 59,355 (75,344) 353,639 9, (Continued)