(g) any <strong>Obligated</strong> Issuer shall fail to pay or provide for the payment of the tender price ofany bond or Master Note when and as the same shall be<strong>com</strong>e due and payable in accordance with the termsof the Master Indenture, of the Bond Indenture or of the Lease if such tender price is not otherwise paid.Remedies. Upon the occurrence of an Event of Default, then and in each and every such case, unless theprincipal of Master Notes shall have already be<strong>com</strong>e due and payable, the Master Trustee may, and if requested bythe holders of, or one or more Related Bond Trustees acting on behalf of, not less than twenty-five percent (25%) inaggregate principal amount of (i) Master Notes of any series then Outstanding, if such Event of Default arises byreason of the failure of any <strong>Obligated</strong> Issuer to pay the principal of, or premium or interest on, any Master Note ofsuch series or by reason of the acceleration of the maturity of any Indebtedness evidenced, collateralized or securedby such Master Notes, or (ii) all Master Notes then Outstanding, if such Event of Default arises for any other reason,the Master Trustee shall, by notice in writing to the <strong>Obligated</strong> Issuers, declare the principal of all Master Notes orthe Master Notes of such series, as the case may be, to be due and payable immediately, and upon any suchdeclaration the same shall be<strong>com</strong>e and shall be immediately due and payable, anything in the Master Indenture or inthe Master Notes contained to the contrary notwithstanding. The provision summarized in this paragraph, however,is subject to the condition that if, at any time after the principal of all Master Notes or the Master Notes of suchseries shall have been so declared due and payable, and before any judgment or decree for the payment of themoneys due shall have been obtained or entered as provided in the Master Indenture, the <strong>Obligated</strong> Issuers shall payor shall deposit with the Master Trustee a sum sufficient to pay all matured installments of interest upon all suchMaster Notes and the principal and premium, if any, of all such Master Notes that shall have be<strong>com</strong>e due otherwisethan by acceleration (with interest on overdue installments of interest and on such principal and premium, if any, atthe rate specified in the Related Supplemental Indenture) and the expenses of the Master Trustee, and any and allEvents of Default under the Master Indenture, other than the nonpayment of principal of and accrued interest onsuch Master Notes that shall have be<strong>com</strong>e due by acceleration, shall have been remedied, the Master Trustee may,and upon the written request of the holders of (i) a majority of the aggregate principal amount of Master Notes ofeach series then Outstanding in respect of which default in the payment of principal, premium or interest occurred(other than by reason of acceleration) either on such Master Notes or any Indebtedness evidenced, collateralized orsecured by such Master Notes, or (ii) the holders of a majority in aggregate principal amount of all Master Notesthen Outstanding, in the case of any other default, shall waive all Events of Default and rescind and annul suchdeclaration and its consequences; but no such waiver or rescission and annulment shall extend to or affect anysubsequent Event of Default, or shall impair any right consequent thereon.In case a default occurs in the payment of any installment of interest on or the principal of any MasterNotes as and when the same shall have be<strong>com</strong>e due and payable, and any <strong>Obligated</strong> Issuer fails to pay the amountsdue upon demand of the Master Trustee, the Master Trustee may institute any actions or proceedings at law or inequity for the collection of the sums so due and unpaid, and may prosecute any actions or proceedings to judgmentor final decree, and may enforce any judgment or final decree against each <strong>Obligated</strong> Issuer, and collect in themanner provided by law out of the Property of each <strong>Obligated</strong> Issuer the moneys adjudged or decreed to be payable.The Master Trustee, upon the bringing of any action or proceeding, as a matter of right, without notice and withoutgiving bond to any <strong>Obligated</strong> Issuer, to the extent permitted by law, may have a receiver appointed of all of theProperty of each <strong>Obligated</strong> Issuer pending the action or proceeding, with the powers conferred by the court makingthe appointment.Upon the happening and continuance of an Event of Default, each <strong>Obligated</strong> Issuer, upon demand of theMaster Trustee, is required forthwith to surrender the possession of, and it is to be lawful for the Master Trustee, bythe officer or agent as it may appoint, to take possession of, all or any part of the Leased Premises, the Leased RealProperty, the Existing Facilities and the Projects, together with the books, papers and accounts of the <strong>Obligated</strong>Issuer pertaining thereto, and including the rights and the position of the <strong>Obligated</strong> Issuer under the Lease or anysubsequent lease or instrument in substitution therefor, and to hold, operate and manage the Leased Premises, theLeased Real Property, the Existing Facilities and the Projects and maintain separate accounts therefor, and from timeto time make all needed repairs and improvements as the Master Trustee shall deem wise.SUITS BY NOTEHOLDERSNo Noteholder shall have any right by virtue of any provisions of the Master Indenture to institute any suit,action or proceeding in equity or at law upon or under or with respect to the Master Indenture or for any otherC-34
emedy thereunder, unless the Noteholder shall have given to the Master Trustee written notice of default and of thecontinuance thereof and (i) the holders of not less than 25% in aggregate principal amount of Outstanding MasterNotes of any series if the Event of Default arises by reason of the failure of any <strong>Obligated</strong> Issuer to pay the principalof, or premium or interest on, any Master Note in that series, or (ii) the holders of not less than a majority inaggregate principal amount of Outstanding Master Notes if such Event of Default arises for any other reason, shallhave made written request upon the Master Trustee to institute the action, suit or proceeding in its own name asMaster Trustee under the Master Indenture and shall have offered to the Master Trustee the reasonable indemnity asit may require against the costs, expenses and liabilities to be incurred, and the Master Trustee, for thirty (30) daysafter its receipt of notice, request and offer of indemnity, shall have neglected or refused to institute any action, suitor proceeding and no direction inconsistent with the written request shall have been given to the Master Trustee byNoteholders.RESIGNATION AND REMOVAL OF MASTER TRUSTEE; SUCCESSOR MASTER TRUSTEEThe Master Trustee may resign at any time without cause by giving at least 10 days’ prior written notice tothe <strong>Obligated</strong> Issuers and to each holder of a Master Note then Outstanding. The resignation shall be effective uponthe acceptance of the master trusteeship by a successor. In addition, the Master Trustee may be removed withoutcause by either the <strong>Obligated</strong> <strong>Group</strong> Representative after giving 30 days notice to all Noteholders of the intent toeffect such removal or by the holders of not less than 50% in aggregate principal amount of Master Notes thenOutstanding, by, in either case, delivering a notice of removal to the Master Trustee, each <strong>Obligated</strong> Issuer and, ifthe removal is effected by the Noteholders, the <strong>Obligated</strong> <strong>Group</strong> Representative, and the Master Trustee shallpromptly give notice of such removal in writing to each holder of a Master Note then Outstanding as provided above.In the case of the resignation or removal of the Master Trustee, a successor trustee may be appointed by the<strong>Obligated</strong> <strong>Group</strong> Representative or, if such appointment has not been made by the <strong>Obligated</strong> <strong>Group</strong> Representative,then the holders of not less than fifty percent (50%) in aggregate principal amount of Master Notes then Outstanding.If a successor trustee shall not have been appointed within 30 days after such notice of resignation or removal, theMaster Trustee, the <strong>Cleveland</strong> <strong>Clinic</strong>, the <strong>Obligated</strong> <strong>Group</strong> Representative, any <strong>Obligated</strong> Issuer or any holder of aMaster Note then Outstanding may apply to any court of <strong>com</strong>petent jurisdiction to appoint a successor to act untilsuch time, if any, as a successor shall have been appointed as above provided. The successor so appointed by suchcourt shall immediately and without further act be superseded by any successor appointed as above provided.SUPPLEMENTS AND AMENDMENTS TO THE MASTER INDENTUREEach <strong>Obligated</strong> Issuer and the Master Trustee may from time to time supplement or amend the MasterIndenture to evidence the succession of another corporation to any <strong>Obligated</strong> Issuer, to add to the covenants of andrestrictions imposed on any <strong>Obligated</strong> Issuer, to cure ambiguities or correct defective or inconsistent provisions inthe Master Indenture or any Supplemental Indenture, to permit qualification of the Master Indenture under the TrustIndenture Act of 1939, to evidence additions to or withdrawals from membership in the <strong>Obligated</strong> <strong>Group</strong>, tosubstitute another Trustee for the Master Trustee or to add a co-Master trustee as provided in the Master Indenture,to amend the provisions of the Master Indenture in the event of a material change in third party reimbursementprinciples, and to make any other change which, in the judgment of the Master Trustee or an Independent Consultant,is not to the prejudice of the Master Trustee or the Noteholders. Any Supplemental Indenture authorized by theprovisions of the Master Indenture summarized in this paragraph may be executed by each <strong>Obligated</strong> Issuer and theMaster Trustee without the consent of the holders of Master Notes then Outstanding, notwithstanding any of theprovisions summarized in the paragraph below.With the consent of the holders of not less than a majority in aggregate principal amount of OutstandingMaster Notes, each <strong>Obligated</strong> Issuer and the Master Trustee may change the Master Indenture in any manner;provided, however, that no Supplemental Indenture shall (i) effect a change in the times, amounts or currency ofpayment of the principal of, premium, if any, or interest on any Master Note or a reduction in the principal amountor redemption price of any Master Note or the rate of interest thereon, without the consent of the Noteholder, or(ii)(a) reduce the aforesaid percentage of Master Notes, the holders of which are required to consent to anysupplemental Master Indenture or (b) except pursuant to the provisions of the Master Indenture summarized in thesecond paragraph under the caption “SUMMARY OF BASIC DOCUMENTS — THE MASTER TRUSTINDENTURE — NOTES ISSUED UNDER THE MASTER INDENTURE” and for subordinated indebtedness, permit thepreference or priority of any Master Note over any other Master Note without the consent of the holders of allC-35
- Page 1 and 2:
NEW ISSUEBOOK ENTRY ONLYSee “RATI
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TABLE OF CONTENTSINTRODUCTORY STATE
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OFFERING CIRCULARRelating to$452,34
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Security and Sources of Payment for
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Upon issuance of the Series 2008A B
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(ii) acquisition of magnetic resona
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$147,200,000 Term Bonds Due January
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that the redemption is conditional
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Use of Certain Terms in Other Secti
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County BondsThe Cleveland Clinic an
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The Cleveland Clinic regularly revi
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ESTIMATED SOURCES AND USES OF FUNDS
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DEBT SERVICE COVERAGEThe following
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MedicareGeneralApproximately 29% of
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there is no assurance that the Obli
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Medicare Conditions of Participatio
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fiscal year’s budget that are in
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Federal Regulatory and Contractual
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Stark-type statutes have fewer exce
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party or for any services rendered
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typically in a position to refer pa
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OhioOhio Certificate of Need Progra
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performance demonstration programs
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manifest injustice would otherwise
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and properties owned or operated by
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plan of reorganization, with one ex
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percentage may be composed wholly o
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The Internal Revenue Service Form 9
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Charity Care, Underinsured and Unin
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• Proposals to eliminate the tax-
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acting in the capacity of underwrit
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Frederick R. Nance, Regional Managi
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FINANCIAL POSITION — D. BALANCE S
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The CommissionBecause the Series 20
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APPENDIX ACLEVELAND CLINIC HEALTH S
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TABLE OF CONTENTSPageINTRODUCTION .
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This Appendix to the Offering Circu
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A. ORIGINS AND FUNDAMENTAL MISSIONT
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C. GOVERNANCE OF THE CLEVELAND CLIN
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Voting Members of theBoard of Trust
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Voting Members of theBoard of Trust
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Principal Operating Officers. The d
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In addition to the broad range of o
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The main campus also includes a com
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GovernanceThe Cleveland Clinic is t
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E. UTILIZATIONThe following tables
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Statistical Information. The follow
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I. COLLABORATIVE PROGRAMSIn additio
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Clinic’s charity care policy, see
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statements filed with Digital Assur
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CLEVELAND CLINIC HEALTH SYSTEMConso
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OBLIGATED GROUPConsolidated Stateme
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PART IV.MANAGEMENT’S DISCUSSION A
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increase in minor equipment purchas
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The following table sets forth the
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pension plans’ funded status in t
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of funding to the pension plan offs
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portfolio. Offsetting the decrease
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• Clinic Care, Inc. (“Clinic Ca
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APPENDIX BCERTAIN FINANCIAL STATEME
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A UDITED C ONSOLIDATED F INANCIAL S
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• Ernst & Young LLPSuite 1300925
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Liabilities and net assetsCurrent l
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Changes in Net AssetsNet AssetsTemp
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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Cleveland Clinic Health SystemNotes
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- Page 173 and 174: APPENDIX CSUMMARY OF BASIC DOCUMENT
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- Page 177 and 178: “Bond Indenture” means the Bond
- Page 179 and 180: period of three months from the com
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- Page 183 and 184: direct, express or charitable trust
- Page 185 and 186: Rate Hedge” for purposes of this
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- Page 191 and 192: provided, however, that Series 2008
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- Page 199 and 200: (b) the Cleveland Clinic, or if the
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- 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