The Cleveland Clinic Foundation Group Return

“William macdonald iii, ccf ,ccef, cchs-east region, fairview, lutheran, and medina trustee, and morry weiss, ccf, ccef, cchs-east region, fairview, lutheran, and medina trustee - business bill sanford, ccf, ccef, cchs-east region, fairview, lutheran, and medina trustee, and larry pollock, ccf, ccef, cchs-east region, fairview, lutheran, and medina trustee - business beth mooney, ccf, ccef, cchs-east region, fairview, lutheran, and medina trustee, and bill sanford, ccf, ccef, cchs-east region, fairview, lutheran, and medina trustee - business larry ruvo, kma director, and camille ruvo, kma director - family larry ruvo, kma and lrbi director, and michael severino, kma and lrbi director - business jeffrey cummings, cc nevada key employee, and xue zhong, cc nevada key employee - family”

“Ccf hotel services inc. Has entered into a management agreement with intercontinental hotels corporation to manage the three hotels owned by ccf hotel services inc.”

“In october 2013, cleveland clinic health system- western region, which had been the sole regular member of fairview hospital and lutheran hospital, dissolved. In anticipation of the dissolution of cchs-wr, the cleveland clinic foundation became the sole regular member of fairview and lutheran hospitals, and both fairview and lutheran hospitals modified their respective articles of incorporation and codes of regulation accordingly. Various changes were made to the cleveland clinic foundation code of regulations to conform to medicare conditions of participation. In addition, a change was made regarding the total number of directors.”

“Pursuant to nonprofit corporation law, there can be no shareholders or other "equity owners" of a nonprofit corporation. Management and control rights are held and exercised by the "members" of the nonprofit corporation. Ccf is an ohio nonprofit corporation and it has both members and trustees/directors. It does not have stockholders. The member of each subordinate in the ccf group is either ccf or an indirect subordinate.”

“Pursuant to nonprofit corporation law, the "members" of the corporation elect the board of directors (trustees), and the board then conducts the affairs of the corporation. In addition, one nonprofit corporation may be the "member" of another nonprofit corporation. Ccf is an ohio nonprofit corporation and it has members who elect the directors. The member of each subordinate in the ccf group is either ccf or an indirect subordinate and that member elects the board of the respective subordinate.”

“Pursuant to nonprofit corporation law, certain of the decisions of the governing bodies must be approved by the members. For example, any changes to the articles of incorporation and code of regulations must be approved by a vote of the members. In addition, certain subordinates in the ccf group each have a "special" member that are other nonprofit tax exempt entities that hold special rights to approve significant transactions or changes such as merger, dissolution, sale of substantially all assets, or a material change in mission.”

“The form 990 is reviewed by experienced and qualified members of the finance division tax department. Prior to filing, key sections of the form are reviewed with experienced and qualified members of the law department. In addition, the entire return is also reviewed with the cfo, the audit committee chairperson and audit committee vice chairperson prior to filing. The paid preparer (big 4 public accounting firm) conducts an in depth review of the form. Annually, the 990 filing is reviewed and discussed with the entire audit committee. Upon confirmation of successful e-filing from the irs, a copy of the final e-filed return will be made available to appropriate members of the governing body. In addition to posting on guidestar, the final e-filed return will be posted on the organization's website at www.clevelandclinic.org.”

“Ccf has adopted a conflict of interest ("coi") policy consistent with the model irs coi policy. It applies to directors, officers and trustees of ccf and all its affiliates, both exempt and taxable. Under the board of directors policy and procedures for dealing with conflict of interest issues (the policy), a trustee or director who has a conflict of interest with respect to a proposed contract, transaction, or arrangement must refrain from voting on any matter relating to the contract, transaction, or arrangement. In addition, the trustees, directors and officers must annually disclose any interests as defined in the policy that may be considered a potential conflict of interest. Failure to timely reply is to be addressed by the committee under the policy. The trustees, officers and directors have a continuing obligation to notify the chief governance officer at any time during the year if any of their disclosures change or if a new disclosure is required under the policy. The board conflict of interest committee meets at least four times a year and reviews the disclosures, any proposed arrangements that may involve a potential conflict of interest, and documents their conclusions. Under the policy, the interested persons may attend a meeting at the discretion of the board or committee to provide information or answer questions, but they may not be present during final consideration or voting on the arrangements.”

“All ccf officers and key employee positions have their compensation reviewed in advance annually by the compensation committee of the ccf board of directors, which is vested with board-delegated powers to act on behalf of the board with respect to compensation matters. In reviewing and establishing compensation for these officers and key employees, the committee uses a process which is intended to create the presumption in regulation 53.4958-6(a) that payments of compensation to these persons constitute reasonable compensation, defined as amounts that are within the range of compensation paid by similarly situated organizations to similarly qualified persons in functionally comparable positions. In this process, no member of the committee who has a conflict of interest within the meaning of regulation 53.4958-6(c)(1)(iii) with respect to the compensation arrangement at issue is permitted to participate in the review and approval of that compensation arrangement. In establishing compensation for employed physicians for physician services, ccf participates in productivity and compensation surveys with similarly situated organizations across the u.s. In addition, ccf engages the services of an independent compensation consultant who each year provides ccf with a customized compensation report regarding physician compensation. By using this data, ccf has been able to develop market-based compensation for physician services. In establishing compensation for officers and key employees performing non-physician services, the compensation committee retains and consults with an independent compensation consultant, who prepares a customized report for the committee regarding amounts paid by similarly situated organizations to similarly qualified persons in functionally comparable positions. The committee uses the market-based data provided by the consultant, and where appropriate, performance reviews and compensation recommendations by the chief executive officer and chief of staff, to establish market-based compensation. After making its compensation decisions, the committee contemporaneously documents its deliberations and decisions in ccf's written or electronic books and records. A small number of employees holding affiliate officer positions have their compensation reviewed and approved by their managers annually within guidelines prescribed by the organization's human resource function. These guidelines take into consideration applicable comparability data and similar compensation metrics.”

“Cchs makes certain of its key documents available to the public on its website, www.clevelandclinic.org, under the "about cleveland clinic" section. In this section, the financial statements, annual report, community benefit report, ccf's conflict of interest policy, and corporate compliance policies are available.”

“The most recently filed form 990 is available on the ccf website, www.clevelandclinic.org, under the "about cleveland clinic" section. All other documents which are required to be available to the public can be obtained upon request.”

“Of the subordinate organizations in the cleveland clinic group exemption, the tax exempt hospital nonprofit corporations have boards that are majority independent. The remaining subordinates are wholly owned subsidiaries many of which have boards comprised in whole or in part by individuals who are officers and/or employees of the parent organization.”

“Cleveland clinic, located in cleveland, ohio, is a nonprofit, tax-exempt academic medical center that integrates clinical and hospital care with research and education. The cleveland clinic is the parent of the cleveland clinic health system. Cleveland clinic was established in 1921 with the same mission that continues today: better care for the sick, investigation of their problems and further education of those who serve. Consistent with its tripartite mission, cleveland clinic's primary program services are focused on patient care provided on a charitable basis, medical research, and education of both medical professionals and the community. The founders recognized that it is in the best interest of patients to pool the talents of medical specialists to develop, teach and apply the best medical techniques. This statement is not intended to identify all the activities by which cleveland clinic fulfills its charitable purposes, but rather is a summary of its primary program services and contributions to the community. In 2013 cleveland clinic and its affiliates provided $652.7 million in benefits to the communities served. The community benefit that the cleveland clinic health system provides includes patient care provided on a charitable basis, research, education, medicaid shortfall, subsidized health services and community outreach programs. The current edition of its community benefit report is available on our website at clevelandclinic.org. (community benefit amounts reported in this program service statement refer to our 2013 community connections, based on the cha reporting methodology. See form 990, schedule h for a reconciliation of schedule h to community benefit reporting.) i. Patient care in 2013, the cleveland clinic health system included an academic medical center and 8 community hospitals (euclid, fairview, hillcrest, lakewood, lutheran, marymount, medina and south pointe hospitals), and a specialty hospital (cleveland clinic children's hospital for rehabilitation) in northeast ohio; one hospital and one health and wellness center in florida; and a center for brain health in las vegas, nevada. Cleveland clinic health system is dedicated to the communities we serve; strives to provide compassionate, high quality healthcare to all who need it; and supports programs and initiatives that improve the health and well-being of our communities. Through our financial assistance efforts and as a leading medicaid provider in ohio, we provide healthcare to those who otherwise could not afford it. In 2013, the cleveland clinic health system recorded 3,535 total staffed beds, 476,144 emergency visits, 202,186 surgical cases, 157,097 admissions, and more than 5.5 million total clinic visits. It is the policy of cleveland clinic health system to treat all patients with compassion, dignity and respect, regardless of their race, creed, or ability to pay. Cleveland clinic's patient care services are provided via patient-oriented institutes, which are structured on the basis of organ system or disease. The institutes facilitate a multidisciplinary approach, and are designed to enhance convenience for patients and the exchange of knowledge, research and educational collaboration for better patient outcomes. Some of the institutes are: anesthesiology, cole eye, digestive disease, emergency services, endocrinology & metabolism, glickman urological & kidney, head & neck, miller family heart & vascular, imaging, medicine, neurological, nursing, ob/gyn & women's health, orthopaedic & rheumatology, pathology & laboratory medicine, pediatric & children's hospital, respiratory, taussig cancer, and wellness. Cleveland clinic florida health system includes a 155-bed hospital, diagnostic centers, outpatient surgery and a 24-hour emergency department in weston, florida. The cleveland clinic florida health and wellness center in west palm beach offers subspecialty medical and radiology services. In 2013, cleveland clinic florida had 445,061 p”

“Marymount hospital, a pathway to excellence(r) hospital for nursing excellence, is accredited by the joint commission and certified as a primary stroke center. It also has strong clinical centers of excellence for surgical services, behavioral health, orthopaedics, emergency services, intensive care and diabetes and endocrine services. Marymount hospital's new 45,000 square foot surgery center is a state-of-the-art facility designed to improve patient outcomes. Medina hospital is the largest health care provider in medina county and specializes in orthopaedics, 24-hour adult emergency care, women's health services, rehabilitation therapies, surgical procedures and diagnostic services. South pointe hospital, a pathway to excellence(r) hospital for nursing excellence, is one of ohio's largest osteopathic teaching hospitals and is the site of the ohio university college of osteopathic medicine center for osteopathic regional education in northeast ohio. In 2013, south pointe became the first cleveland clinic community hospital to offer pre-transplant evaluations for potential kidney transplantation patients. South pointe is cleveland clinic health system's eighth primary stroke center in northeast ohio. Cleveland clinic florida is a world-renowned academic medical center with one of the largest graduate medical education programs in south florida. For the fourth year in a row, cleveland clinic florida ranked highest among hospitals in broward county in regional rankings in u.s. News & world report's ranking of best hospitals 2013-2014. The cleveland clinic lou ruvo center for brain health continues to establish a unique clinical trials network to advance the development of new therapies for alzheimer's disease and other cognitive disorders. Financial assistance the cleveland clinic financial assistance policy not only assists the poorest of the poor by providing free care for medically necessary services to uninsured patients with incomes up to 250 percent of the federal poverty level but also offers discounts on medically necessary services for uninsured patients whose income is up to 400 percent of the poverty level. Patients with exceptional circumstances may also be eligible for financial assistance. This policy is designed to prevent medical bills from causing a patient or family undue financial hardship. The cleveland clinic health system provided financial assistance at a cost of $169.8 million in 2013. Ii. Research cleveland clinic's mission includes conducting research to advance biomedical science and ultimately improve patient care, prevent disease, and find cures for medical issues. Cleveland clinic's lerner research institute ("lri") is its research institute and home to a complete spectrum of laboratory-, translational-, and clinical-based research. Lri has 172 faculty -level scientists organized in the following departments: biomedical engineering, cancer biology, cellular and molecular medicine, genomic medicine, immunology, molecular cardiology, molecular genetics, neurosciences, ophthalmic research, pathobiology, quantitative health sciences, stem cell biology and regenerative medicine, and translational hematology and oncology research. Lri is one of the leading nih-funded research institutes in the united states and has spearheaded numerous advances in the diagnosis and treatment of complex medical problems. Scientists and their teams are pursuing a wide range of biomedical questions at lri, including those related to cardiovascular, cancer, neurological, musculoskeletal, and metabolic diseases. Altogether, nearly 2,000 scientists and support personnel work at lri. This includes more than 200 postdoctoral fellows, nearly 170 graduate students and 200 undergraduate students. In addition to basic pre-clinical research, the cleveland clinic, its affiliates and employed physicians participate or are primary investigators in many clinical trials. In 2013, cleveland clinic was involved in approximately 1000 clinical”

“Center for health sciences education cleveland clinic is a major education and training site for a number of allied health students from various academic programs throughout the region. The cleveland clinic health system currently offers 15 in-house allied health programs and has 49 affiliated programs with regional academic institutions. In 2013, cleveland clinic health system hosted more than 2,100 clinical rotations for health science students. Center for international medical education the center for international medical education (cime) is responsible for coordinating cleveland clinic's international educational initiatives and for ensuring the provision of high quality educational experiences for the global medical community. In 2013, 750 international physicians and medical students traveled to cleveland clinic to participate in observerships; 255 physicians attended symposia held at cleveland clinic in patient experience, cardiology, colorectal surgery, spine surgery, gastroenterology, urology, pediatrics, breast cancer and obesity; and our own staff traveled to more than 15 countries to share clinical and surgical innovations. Iv. Additional community benefit community education educating the community has also been a priority of cleveland clinic health system. Our center for consumer health information is expanding knowledge through a variety of media while making information available to patients and the northeast ohio community. Following are some of the programs offered in 2013: health information resource center: the patient and family health and education center on main campus is a place where patients, visitors and employees can take advantage of health information resources prepared for the general public. The consumer health information staff also fulfills requests for health information made in writing, by email or by phone. In 2013, the center fulfilled 9,514 requests and served 13,564 people who came into the center for information. Health talks/health exchange and cctv: the center for consumer health information hosted 29 community health talks/health exchange programs managed 3,585 scheduled closed-circuit television weekly programs and approximately 359 weekly on-demand televised programs. Internet site: the center for consumer health information website (www.clevelandclinic.org/health) continues to be a source of information for users around the world. The website also features live webchats with a health educator, allowing the public to post questions and have them answered in real time. Webchats take place monday through friday, from 9:00 am to 3:00 pm. By the end of 2013, we held 6,629 webchats. Medicaid shortfall the cleveland clinic health system is a leading provider of medicaid services in ohio. In many states, including ohio, medicaid payments have not been sufficient to cover the cost of treating medicaid beneficiaries. In 2013, the health system's unpaid medicaid costs were $124.0 million (this figure is net of an hcap benefit of $17.7 million). Subsidized health services in addition to charity care and costs not covered by medicaid payments, another clinical community benefit category is "subsidized health services." these services yield low or negative margins but are needed in the community. Cleveland clinic provided subsidized health services in 2013 at a cost of $16.7 million. Community outreach programs the cleveland clinic health system is actively engaged in a broad array of community outreach programs, providing or contributing to more than 300 such programs in 2013 for a total net community benefit of $50.0 million. These programs are designed to serve the vulnerable and at-risk populations in our communities. Our well-established outreach programs range from free wellness initiatives, health screenings, clinical services and education to enrollment assistance for government-funded health programs. Community outreach programs fall into three main categories: community health servic”

“Transfer of net assets 330,373. Net assets released from restriction used for capital purposes 1,212,091. Gifts and bequests 75,181,752. Net investment income 30,555,853. Net assets released from restriction used for operations -36,726,581. Retirement benefits adjustment 225,976,711. Net change in unrealized gains on nontrading investments -93,292. Equity transfers 4,518,917. Change in interest of trusts 3,936,939. Combined reporting adjustment -356,000.”