The Cleveland Clinic Foundation Group Return

“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 joseph scaminace, ccf, ccef, medina, cchs-east region, fairview, lutheran, and medina trustee and william reidy, ccf, ccef, medina, cchs-east region, fairview, lutheran, and medina trustee - business ronald weinberg, ccf director, and william peacock, ccf director and officer - business”

“Ccf hotel services, llc, a single member disregarded entity of ccf, has entered into a management agreement with intercontinental hotels corporation to manage the two hotels owned by ccf hotel services, llc.”

“The code of regulations of lakewood hospital were amended to authorize the member to make immediate and ongoing actions related to the wind down of the operation of the hospital facility.”

“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. The cleveland clinic health system defines and measures community benefit (including financial assistance) using the catholic health association ("cha") community benefit model, which recommends reporting financial assistance on a cost basis. Using this model, in 2015 cleveland clinic and its affiliates provided $692.8 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 community benefit report is available on our website at clevelandclinic.org. (community benefit amounts reported in this program service statement refer to our 2015 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 2015, 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 striving to provide compassionate, high quality healthcare to all who need it; and supporting 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 2015, the cleveland clinic health system recorded 4,034 total staffed beds, 640,215 emergency visits, 208,807 surgical cases, 178,528 admissions, and more than 6.6 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 is a world-renowned academic medical center with one of the la”

“Fairview hospital is a regional hospital and certified level ii trauma center with 488 licensed beds located in cleveland, oh. Fairview is also home to a fully accredited breast center through national accreditation program for breast centers, american college of surgeons. According to the u.s. News & world report 2015-2016 ranking, fairview ranks number 4 in the cleveland metro area. In 2015, fairview was designated a joint commission 'top performer' for heart attack, heart failure, pneumonia, surgical care, stroke, and perinatal care based on their evidence-based care and also designated a blue distinction center for maternity and cardiac care by the blue cross blue shield association. Awards also include the american heart association/american stroke association get with the guidelines - stroke award and the outstanding achievement award by the american college of surgeons, commission on cancer for the integrated network cancer program. The society of thoracic surgeons also cited fairview as 3-star (out of 3 stars) in their annual report. In 2015, fairview opened a new, 4-bed adult epilepsy monitoring unit that is monitored remotely by the cleveland clinic central monitoring unit (cmu). Hillcrest hospital is a regional hospital and certified level ii trauma center with 496 licensed beds located in mayfield heights, oh. Hillcrest is also home to a level iii neonatal intensive care unit for critically ill babies and a certified cardiac and pulmonary rehabilitation program through american association of cardiovascular and pulmonary rehabilitation (aacvpr). According to the u.s. News & world report 2015-2016 ranking, hillcrest ranks number 3 in the cleveland metro area. Hillcrest was also designated by u.s. News & world report as a 'high performer' in heart failure and copd and received blue distinction+ designation for maternity care and knee/hip replacement and blue distinction designation for cardiac care. Awards also include the american heart association/american stroke association get with the guidelines - stroke award and a 3-star rating (out of 3 stars) from the society of thoracic surgeons. Lutheran hospital is an area leader in geriatric and adult behavioral health, spine care, orthopaedics, and wound care. The alcohol and drug recovery center (adrc) at lutheran hospital offers the highest quality evaluation and treatment for patients with alcohol and/or drug dependency problems by a team of highly qualified specialists. With 204 beds, lutheran hospital is located on the westside of cleveland, oh. The u.s. News & world report 2015-2016 ranking ranks lutheran as the number 7 hospital in the cleveland metro area. Lutheran is designated a 'top performer' by the joint commission in surgical care and pneumonia and is also designated a blue distinction+ center for spine care and knee/hip replacement by the blue cross blue shield association. Additionally, lutheran continues to expand its bi-lingual/bi-cultural services to support its diverse community through the hispanic clinic, which is comprised of primary and specialty care physicians as well as support staff. Marymount hospital is a 315 bed, faith-based regional hospital located in garfield heights, oh. Marymount hospital is certified as a primary stroke center, and in 2015, the american heart association/american stroke association presented marymount with its get with the guidelines - stroke award. Marymount is also home to an accredited behavioral health program. For knee and hip replacement, marymount is designated as a blue distinction+ center by the blue cross blue shield association. Medina hospital, located in medina, oh, is the largest health care provider in medina county with 157 licensed beds. With many specialties, medina hospital is home to a family birthing center, new wound care center with a hyperbaric trailer, and a new tele-neurology program. Medina hospital's primary stroke center has achieved the american heart association/american stroke associat”

“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 located on the main campus and home to a complete spectrum of laboratory-, translational-, and clinical-based research. Lri has approximately 172 faculty-level scientists organized in the following departments: biomedical engineering, cancer biology, cellular and molecular medicine, genomic medicine, immunology, molecular cardiology, 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 1,500 scientists and support personnel work at lri. This includes approximately 200 postdoctoral fellows, 80 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 2015, cleveland clinic was involved in approximately 4,420 active human subjects' research studies. The ongoing collaboration between physician investigators and study volunteers is central to testing the safety and effectiveness of drugs and medical procedures and helps to set the standards for patient care. Research at cleveland clinic is funded by external sources, such as federal grants, but is also substantially supported by the clinic's own internal resources. In 2015, cleveland clinic provided community benefit in research at a subsidized cost of more than $204.1 million, which included externally- sponsored funding of $137.1 million. The cleveland clinic health system's research activities are intended to improve patient care and the health of the public at large, by providing the latest advances in medicine directly to patients and by refining the practice of medicine through the development and promulgation of new techniques, devices, and treatment protocols. Iii. Education on its main campus, cleveland clinic operates a medical school and related research institute. The primary focus of cleveland clinic lerner college of medicine of case western reserve university (the "lerner college of medicine") is the teaching and training of medical students who have a particular interest in research. Many cleveland clinic physicians serve as faculty for the lerner college of medicine, furthering the integration of clinical care with research and education. The lerner college of medicine currently provides all students with full tuition scholarships. In addition to training this nation's future doctors, cleveland clinic sponsors a wide range of high quality medical education training throughout the health system including accredited training programs for nurses and health science professionals. Cleveland clinic health system devotes substantial resources to education programs, which, in 2015, provided a net community benefit of $256.5 million. These educational activities ensure residents and patients in all of the cleveland clinic health system's communities are receiving the highest standard of medical care and have trained health professionals to care for them in the future. Some of these education programs include: graduate medical education: cleveland clinic maintains one of the largest graduate medical education programs in the country. In 2015, 1,348 residents and fellows trained in 99 accredited training programs, approved by the accreditation counc”

“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 2015, we held 10,055 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 2015, the health system's unpaid medicaid costs were $242.7 million (this figure is net of an hcap benefit of $12.3 million). Subsidized health services in addition to financial assistance 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 2015 at a cost of $18.6 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 outreach activities for a total net community benefit of $38.7 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. Outreach programs address documented health needs of our communities and fall into three main categories: community health services, cash and in-kind donations, and community building. In 2015, some highlights included: -wellness initiatives in the areas of disease/injury prevention and behavioral change, including tobacco cessation, nutrition improvement, exercise, help with substance abuse, child safety, teen parenting and domestic violence. Programs were provided to schools, faith-based organizations, community centers, collaborating cities and counties. -health fairs provided thousands of people with free health screenings.. The cleveland clinic minority men's health fair, celebrating sisterhood, and neighborhood fairs educated community members on the benefits of preventative care. -cleveland clinic provided no-cost clinical care to under- and uninsured families at community sites, including langston hughes health & education center and the pediatric mobile unit, which provided wellness services to our communities. In addition, laboratory and vision services were donated to cleveland-area organizations. -community classes and interactive webchats offered health education on chronic disease management in the areas of heart disease, stroke, cancer, diabetes, asthma and brain health. Our hospitals and family health centers provided classes for healthy senior and youth lifestyles. -the let's move it initiative connected residents with local resources in a collaborative effort to strengthen communities through wellness activities, academic achievement and career preparedness. -community farmers markets, urban gardens and a mobile food pantry provided access to fresh local products and supplemental food programs. V. Conclusion the purpose of the cleveland clinic health system is to benefit humanity through the efficient, effective, and ethical practice of medicine, by advancing scientific investigation and medical education, by maintaining the highest standards of quality, and by fostering creativity and innovation.”

“Donated capital and assets released from restriction for capital purposes 45,740. Gifts and bequests 131,340,468. Transfer of net assets -147,589,712. Net investment income -596,036. Net assets released from restriction used for operations -44,060,610. Retirement benefits adjustment 25,546,013. Net change in unrealized gains on non-trading investments -4,946,537. Change in interests in foundations -17,350,694. Equity transfers -18,489,933. Equity adjustment 231,458. Combined reporting adjustment 650,000. Rounding -2.”