<strong>Obligated</strong> <strong>Group</strong> presented as in (i) above as of the end of such Fiscal Year, each ac<strong>com</strong>panied by the certificate oropinion of independent certificated public accountants, in each case in <strong>com</strong>parative form showing the correspondingfigures for the preceding Fiscal Year, and (iii) an Officer’s Certificate from the <strong>Obligated</strong> <strong>Group</strong> Representativesetting forth his calculations of the Debt Service Coverage Ratio of the Combined <strong>Group</strong> for the Fiscal Year thenended.For purposes of financial statements of the Combined <strong>Group</strong> or the <strong>Obligated</strong> <strong>Group</strong> required to bedelivered by the provisions of the Master Indenture summarized under this caption, such financial statements shallconsist of (i) special purpose financial statements including only the members of the Combined <strong>Group</strong> or the<strong>Obligated</strong> <strong>Group</strong> or (ii) consolidated or <strong>com</strong>bined financial statements which include one or more members of theCombined <strong>Group</strong> or <strong>Obligated</strong> <strong>Group</strong>, as the case may be, and one or more other Persons required to be consolidatedor <strong>com</strong>bined with such member(s) of the Combined <strong>Group</strong> or <strong>Obligated</strong> <strong>Group</strong> under generally accepted accountingprinciples, so long as any financial statements which include any other Persons who are not members of theCombined <strong>Group</strong> or <strong>Obligated</strong> <strong>Group</strong> shall contain, as “other financial information,” a <strong>com</strong>bining or consolidatingschedule from which financial information relating solely to the members of the Combined <strong>Group</strong> or <strong>Obligated</strong><strong>Group</strong>, as the case may be, may be derived. If a single financial statement (including a single special purposefinancial statement) is delivered pursuant to the foregoing provisions of clause (ii) in which the members of theCombined <strong>Group</strong> or the <strong>Obligated</strong> <strong>Group</strong> represent at least 90% of the <strong>com</strong>bined or consolidated in<strong>com</strong>e availablefor debt service (calculated in the same manner as In<strong>com</strong>e Available for Debt Service is calculated under the MasterIndenture) of all Persons included in such single financial statement, at the written election of the <strong>Obligated</strong> <strong>Group</strong>Representative delivered to the Master Trustee simultaneous with the delivery of such single financial statement tothe Master Trustee, such single financial statement may be designated as the “financial statements of the Combined<strong>Group</strong>” or the “financial statements of the <strong>Obligated</strong> <strong>Group</strong>” by the <strong>Obligated</strong> <strong>Group</strong> Representative for all purposesof the Master Indenture and shall, upon such designation, be treated as such.As soon as practicable but in no event later than six months after the end of each Fiscal Year, the <strong>Obligated</strong><strong>Group</strong> Representative is required to file with the Master Trustee an Officer’s Certificate of each <strong>Obligated</strong> Issuerstating whether or not, to the best knowledge of the signer, the <strong>Obligated</strong> Issuer is in default in the performance ofany covenant contained in the Master Indenture or any Related Supplemental Indenture, and, if so, specifying theaction proposed to be taken to correct or cure the same and each default of which the signer may have knowledge.If an Event of Default has occurred and is continuing, the <strong>Obligated</strong> <strong>Group</strong> Representative will (i) file withthe Master Trustee such other financial statements and information concerning the operations and financial affairs ofeach <strong>Obligated</strong> Issuer (or of any consolidated group of <strong>com</strong>panies of which such <strong>Obligated</strong> Issuer is a member) asthe Master Trustee may from time to time reasonably request, excluding specifically donor records, patient records,personnel records, medical staff records, medical staff <strong>com</strong>mittee records, and any other records the confidentialityof which may be protected by law, and (ii) provide access to the facilities of such <strong>Obligated</strong> Issuer for the purpose ofinspection by the Master Trustee during regular business hours or at such other times as the Master Trustee mayreasonably request.Within 10 days after receipt thereof by any <strong>Obligated</strong> Issuer, the <strong>Obligated</strong> <strong>Group</strong> Representative isrequired to file with the Master Trustee a copy of each report which any provision of the Master Indenture requiresto have been prepared by an Independent Consultant or an Independent Insurance Consultant.RATE COVENANTIf the Debt Service Coverage Ratio of the Combined <strong>Group</strong> as calculated at the end of any Fiscal Year inthe Officer’s Certificate of the <strong>Obligated</strong> <strong>Group</strong> Representative pursuant to the provisions of the Master Indenture isbelow 1.10, the <strong>Obligated</strong> <strong>Group</strong> covenants to promptly notify each Related Bond Trustee of such fact and to retainan Independent Consultant to make re<strong>com</strong>mendations (which may include, without limitation, increasing rates andcharges, reducing operating costs, adjusting the patient mix, altering the intensity or scope of services or any<strong>com</strong>bination of the foregoing) to increase the Debt Service Coverage Ratio to at least 1.10. Each <strong>Obligated</strong> Issuerwill, and will cause each <strong>Group</strong> Affiliate which it controls to, to the extent feasible, follow the re<strong>com</strong>mendations ofthe Independent Consultant and, so long as the <strong>Obligated</strong> <strong>Group</strong> shall retain an Independent Consultant and each<strong>Obligated</strong> Issuer and <strong>Group</strong> Affiliate shall follow such Independent Consultant’s re<strong>com</strong>mendations with respect tosuch <strong>Obligated</strong> Issuer or <strong>Group</strong> Affiliate to the extent feasible, the provisions of the Master Indenture summarizedC-30
under this caption shall be deemed to have been <strong>com</strong>plied with even if the Debt Service Coverage Ratio for anysubsequent Fiscal Year is below 1.00. The <strong>Obligated</strong> <strong>Group</strong> need not employ an Independent Consultant in theFiscal Year immediately following the Fiscal Year in which an Independent Consultant’s re<strong>com</strong>mendations arereceived if in such Fiscal Year the aforesaid Debt Service Coverage Ratio is not met.MERGER AND CONSOLIDATIONEach <strong>Obligated</strong> Issuer shall not, and shall not permit any <strong>Group</strong> Affiliate which it controls to, and shall notpermit any Affiliate which it controls and which controls a <strong>Group</strong> Affiliate to permit that <strong>Group</strong> Affiliate to,consolidate with or merge into any corporation or convey or transfer its Property substantially as an entirety to anyPerson, unless (a) the consolidation, merger, transfer or conveyance is between two <strong>Obligated</strong> Issuers or between<strong>Group</strong> Affiliates or an <strong>Obligated</strong> Issuer and a <strong>Group</strong> Affiliate or (b) all the following conditions exist: (i) the Personformed by the consolidation or into which the <strong>Obligated</strong> Issuer or <strong>Group</strong> Affiliate merges, or the Person acquiringsubstantially all of the Property of the <strong>Obligated</strong> Issuer or <strong>Group</strong> Affiliate as an entirety, shall be a Person organizedand existing under the laws of the United States of America or any state or the District of Columbia and if themerging, consolidating or transferring Person is an <strong>Obligated</strong> Issuer, shall be<strong>com</strong>e an <strong>Obligated</strong> Issuer and shallexpressly assume the due and punctual payment of the principal of and premium, if any, and interest on all MasterNotes and the performance and observance of every covenant and condition of the Master Indenture to be performedor observed on the part of an <strong>Obligated</strong> Issuer; (ii) the <strong>Obligated</strong> <strong>Group</strong> Representative delivers to the MasterTrustee an Officer’s Certificate to the effect that (A) the Debt Service Coverage Ratio of the Combined <strong>Group</strong>obtained using Net In<strong>com</strong>e Available for Debt Service for the most recent Fiscal Year for which audited financialstatements are available and assuming that the proposed transaction took place at the beginning of that Fiscal Year(x) is not less than 1.20, or (y) is not less than 1.15 and the forecasted Debt Service Coverage Ratio of the Combined<strong>Group</strong> for each of the two full Fiscal Years after the <strong>com</strong>pletion of the proposed transaction, as evidenced by areport or opinion of an Independent Consultant, is not less than 1.15; or (B) the Fund Balance of the Combined<strong>Group</strong> following such transaction will not be less than 85% of the Fund Balance of the Combined <strong>Group</strong>immediately prior to such transaction; (iii) immediately after giving effect to the transaction, no Event of Defaultunder the Master Indenture shall have occurred and be continuing; and (iv) the <strong>Obligated</strong> <strong>Group</strong> Representative shallhave delivered to the Master Trustee an Officer’s Certificate and an Opinion of Counsel, each of which shall statethat the transaction <strong>com</strong>plies with the Master Indenture, will not adversely affect the tax treatment under the Code ofinterest on any Related Bonds secured by any Outstanding Master Note, and there has been <strong>com</strong>pliance with allconditions precedent which relate to the transaction.Upon any consolidation or merger, or any conveyance or transfer of the Property of an <strong>Obligated</strong> Issuersubstantially as an entirety, the successor Person formed by the consolidation or into which the <strong>Obligated</strong> Issuer ismerged or to which the conveyance or transfer is made, will succeed to, be substituted for, and may exercise everyright and power of the <strong>Obligated</strong> Issuer under the Master Indenture with the same effect as if the successor Personhad been named as an <strong>Obligated</strong> Issuer. If the Person making the conveyance or transfer has not previously beendischarged from its liability as obligor and Maker on the Master Notes, it will then be discharged.GROSS RECEIPTS PLEDGETo secure the prompt payment of the principal of and interest and any premium on each Master Note, andthe observance and performance by each Member of all of its covenants, agreements and obligations under theMaster Indenture, each Member pledges, assigns and grants to the Master Trustee, and covenants, agrees andacknowledges that the Master Trustee shall have, to the extent permitted by law, an assignment of and securityinterest in the Gross Receipts of each Member.The provisions of the preceding paragraph are subject, however, to the right of each Member to collect,maintain custody of and use and dispose of its Gross Receipts, subject only to any restriction imposed by the MasterIndenture on the encumbrance by Members of their Property; provided that, upon the occurrence and continuation ofan Event of Default under the Master Indenture, that right to maintain custody of, use and dispose of Gross Receiptsshall be suspended upon delivery to the <strong>Obligated</strong> <strong>Group</strong> Representative by the Master Trustee of written notice thatthe Gross Receipts are to be in the custody of the Master Trustee, and immediately thereafter, the Gross Receiptsshall be deposited, as and when collected by each Member, with the Master Trustee, unless and until the Event ofDefault is waived or cured; provided, however, that such Gross Receipts may be released to any Member uponC-31
- Page 1 and 2:
NEW ISSUEBOOK ENTRY ONLYSee “RATI
- Page 3 and 4:
TABLE OF CONTENTSINTRODUCTORY STATE
- Page 5 and 6:
OFFERING CIRCULARRelating to$452,34
- Page 7 and 8:
Security and Sources of Payment for
- Page 9 and 10:
Upon issuance of the Series 2008A B
- Page 11 and 12:
(ii) acquisition of magnetic resona
- Page 13 and 14:
$147,200,000 Term Bonds Due January
- Page 15 and 16:
that the redemption is conditional
- Page 17 and 18:
Use of Certain Terms in Other Secti
- Page 19 and 20:
County BondsThe Cleveland Clinic an
- Page 21 and 22:
The Cleveland Clinic regularly revi
- Page 23 and 24:
ESTIMATED SOURCES AND USES OF FUNDS
- Page 25 and 26:
DEBT SERVICE COVERAGEThe following
- Page 27 and 28:
MedicareGeneralApproximately 29% of
- Page 29 and 30:
there is no assurance that the Obli
- Page 31 and 32:
Medicare Conditions of Participatio
- Page 33 and 34:
fiscal year’s budget that are in
- Page 35 and 36:
Federal Regulatory and Contractual
- Page 37 and 38:
Stark-type statutes have fewer exce
- Page 39 and 40:
party or for any services rendered
- Page 41 and 42:
typically in a position to refer pa
- Page 43 and 44:
OhioOhio Certificate of Need Progra
- Page 45 and 46:
performance demonstration programs
- Page 47 and 48:
manifest injustice would otherwise
- Page 49 and 50:
and properties owned or operated by
- Page 51 and 52:
plan of reorganization, with one ex
- Page 53 and 54:
percentage may be composed wholly o
- Page 55 and 56:
The Internal Revenue Service Form 9
- Page 57 and 58:
Charity Care, Underinsured and Unin
- Page 59 and 60:
• Proposals to eliminate the tax-
- Page 61 and 62:
acting in the capacity of underwrit
- Page 63 and 64:
Frederick R. Nance, Regional Managi
- Page 65 and 66:
FINANCIAL POSITION — D. BALANCE S
- Page 67 and 68:
The CommissionBecause the Series 20
- Page 69 and 70:
APPENDIX ACLEVELAND CLINIC HEALTH S
- Page 71 and 72:
TABLE OF CONTENTSPageINTRODUCTION .
- Page 73 and 74:
This Appendix to the Offering Circu
- Page 75 and 76:
A. ORIGINS AND FUNDAMENTAL MISSIONT
- Page 77 and 78:
C. GOVERNANCE OF THE CLEVELAND CLIN
- Page 79 and 80:
Voting Members of theBoard of Trust
- Page 81 and 82:
Voting Members of theBoard of Trust
- Page 83 and 84:
Principal Operating Officers. The d
- Page 85 and 86:
In addition to the broad range of o
- Page 87 and 88:
The main campus also includes a com
- Page 89 and 90:
GovernanceThe Cleveland Clinic is t
- Page 91 and 92:
E. UTILIZATIONThe following tables
- Page 93 and 94:
Statistical Information. The follow
- Page 95 and 96:
I. COLLABORATIVE PROGRAMSIn additio
- Page 97 and 98:
Clinic’s charity care policy, see
- Page 99 and 100:
statements filed with Digital Assur
- Page 101 and 102:
CLEVELAND CLINIC HEALTH SYSTEMConso
- Page 103 and 104:
OBLIGATED GROUPConsolidated Stateme
- Page 105 and 106:
PART IV.MANAGEMENT’S DISCUSSION A
- Page 107 and 108:
increase in minor equipment purchas
- Page 109 and 110:
The following table sets forth the
- Page 111 and 112:
pension plans’ funded status in t
- Page 113 and 114:
of funding to the pension plan offs
- Page 115 and 116:
portfolio. Offsetting the decrease
- Page 117 and 118:
• Clinic Care, Inc. (“Clinic Ca
- Page 119 and 120:
APPENDIX BCERTAIN FINANCIAL STATEME
- Page 121 and 122:
A UDITED C ONSOLIDATED F INANCIAL S
- Page 123 and 124:
• Ernst & Young LLPSuite 1300925
- Page 125 and 126:
Liabilities and net assetsCurrent l
- Page 127 and 128:
Changes in Net AssetsNet AssetsTemp
- Page 129 and 130:
Cleveland Clinic Health SystemNotes
- Page 131 and 132:
Cleveland Clinic Health SystemNotes
- Page 133 and 134:
Cleveland Clinic Health SystemNotes
- Page 135 and 136:
Cleveland Clinic Health SystemNotes
- Page 137 and 138:
Cleveland Clinic Health SystemNotes
- Page 139 and 140:
Cleveland Clinic Health SystemNotes
- Page 141 and 142:
Cleveland Clinic Health SystemNotes
- Page 143 and 144:
Cleveland Clinic Health SystemNotes
- Page 145 and 146:
Cleveland Clinic Health SystemNotes
- Page 147 and 148:
Cleveland Clinic Health SystemNotes
- Page 149 and 150:
Cleveland Clinic Health SystemNotes
- Page 151 and 152:
Cleveland Clinic Health SystemNotes
- Page 153 and 154: Cleveland Clinic Health SystemNotes
- Page 155 and 156: Cleveland Clinic Health SystemNotes
- Page 157 and 158: Cleveland Clinic Health SystemNotes
- Page 159 and 160: Other Financial Information
- Page 161 and 162: • Ernst & Young LLPSuite 1300925
- Page 163 and 164: Liabilities and net assetsCurrent l
- Page 165 and 166: Liabilities and net assetsCurrent l
- Page 167 and 168: Cleveland Clinic Health SystemConso
- Page 169 and 170: Cleveland Clinic Health SystemConso
- Page 171 and 172: Cleveland Clinic Health SystemNotes
- Page 173 and 174: APPENDIX CSUMMARY OF BASIC DOCUMENT
- Page 175 and 176: APPENDIX CSUMMARY OF BASIC DOCUMENT
- Page 177 and 178: “Bond Indenture” means the Bond
- Page 179 and 180: period of three months from the com
- Page 181 and 182: PROPERTY”, and all improvements,
- Page 183 and 184: direct, express or charitable trust
- Page 185 and 186: Rate Hedge” for purposes of this
- Page 187 and 188: Debt according to a fixed schedule
- Page 189 and 190: “Officer’s Certificate” means
- Page 191 and 192: provided, however, that Series 2008
- Page 193 and 194: (t) liens on money or obligations d
- Page 195 and 196: Project Administrator. In the event
- Page 197 and 198: “Stated Maturity” means, when u
- Page 199 and 200: (b) the Cleveland Clinic, or if the
- Page 201 and 202: (d) the Master Trustee receives an
- Page 203: (g) the loan of cash or other non-O
- Page 207 and 208: Supplemental Indenture to which suc
- Page 209 and 210: emedy thereunder, unless the Noteho
- Page 211 and 212: purchase or other acquisition or re
- Page 213 and 214: limitation, (A) the Special Funds a
- Page 215 and 216: (b) Default in the payment of the p
- Page 217 and 218: Fund Requirements, in the order of
- Page 219 and 220: (g) to evidence the appointment of
- Page 221 and 222: THE LEASEThe Lease contains various
- Page 223 and 224: (a) Failure by the Cleveland Clinic
- Page 225 and 226: APPENDIX DPROPOSED FORM OF OPINION
- Page 227 and 228: PROPOSED TEXT OF LEGAL OPINION OFSQ
- Page 229 and 230: October __, 2008Page 32008A Bonds c