CLEVELAND CLINIC HEALTH SYSTEMNORTHEAST OHIO SERVICE AREA AND FACILITIESIn recent years, the <strong>Cleveland</strong> <strong>Clinic</strong> has engaged in several efforts to advance its educational and researchmission. In July 2004, the <strong>Cleveland</strong> <strong>Clinic</strong> and Case Western Reserve University (“CWRU”) School of Medicinelaunched the <strong>Cleveland</strong> <strong>Clinic</strong> Lerner College of Medicine of Case Western Reserve University (the “College ofMedicine”). Its primary focus is the teaching and training of medical students who have a particular interest inresearch, and many of the <strong>Cleveland</strong> <strong>Clinic</strong>’s world-renowned physicians serve as faculty for the College ofMedicine, furthering the integration of clinical care with research and education.Florida. In 1988, the <strong>Cleveland</strong> <strong>Clinic</strong> established Florida <strong>Clinic</strong>, a group medical practice operating anoutpatient medical facility in Fort Lauderdale, Florida. In mid-2001, the operations of Florida <strong>Clinic</strong> were moved tothe Weston <strong>Clinic</strong>, and in October 2006, CCF Florida Hospital Corporation became the owner and operator of theWeston Hospital. The <strong>Cleveland</strong> <strong>Clinic</strong> also established, in 1999 through Florida <strong>Clinic</strong> and in 2001 through CCFFlorida Hospital Corporation, respectively, an outpatient medical facility and an adjacent 75-bed hospital in Naples,Florida, both of which were sold in May 2006. See “PART II – THE OBLIGATED GROUP – C. FLORIDA.”Expansion outside Existing Markets. The <strong>Cleveland</strong> <strong>Clinic</strong> has entered into several alliances with outsideparties to promote development outside northeast Ohio of the <strong>Cleveland</strong> <strong>Clinic</strong>’s integrated, academic group practicemodel and the practice procedures resulting from that model. These include clinical affiliations with other U.S.hospitals to strengthen their existing programs through standardization of practices, protocols and related work; theopening of an executive health clinic in Toronto, Ontario, offering physical examinations, diagnostics and treatment;and an agreement to help establish, develop and operate a specialty hospital in the United Arab Emirates to beknown as <strong>Cleveland</strong> <strong>Clinic</strong> Abu Dhabi, as well as working with the <strong>Health</strong> Authority of Abu Dhabi to manage andoperate Sheikh Khalifa Medical City, a network of healthcare facilities in Abu Dhabi. In addition, the <strong>Cleveland</strong><strong>Clinic</strong>’s eRadiology Department provides offsite health care providers with radiology services, including reading ofMRI, CT and other images. Finally, through its website, the <strong>Cleveland</strong> <strong>Clinic</strong> offers the “MyConsult” RemoteSecond Medical Opinion Service.A-4
C. GOVERNANCE OF THE CLEVELAND CLINICThe <strong>Cleveland</strong> <strong>Clinic</strong> is the sole member or sole regular member of each Affiliate within the <strong>Health</strong> <strong>System</strong>,or of an Affiliate’s direct or indirect parent. The various corporate entities that <strong>com</strong>prise the <strong>Health</strong> <strong>System</strong> each hasits own board of trustees and officers. The <strong>Cleveland</strong> <strong>Clinic</strong> governs the <strong>Health</strong> <strong>System</strong> through directrepresentation on such boards of trustees, reserved powers and other governance controls. The <strong>Cleveland</strong> <strong>Clinic</strong> isgoverned by its Members, a Board of Trustees, a Board of Governors and its principal operating officers.Members. The members of the <strong>Cleveland</strong> <strong>Clinic</strong> (“Members”) are elected by existing voting Members,either for fixed or determinable periods of time, or for life. The classes of Members are (1) Life, (2) Active Trustee,(3) Professional Staff, and (4) Distinguished Fellows. Members of each such class must possess specificqualifications that are delineated in the Code of Regulations. Only Life and Active Trustee members have votingrights. The Members meet at least annually to elect new Trustees to the Board of Trustees, to consider and adoptamendments to the governing documents and to act upon such other matters as may be appropriate. Currently, thereare 77 voting Members and approximately 124 other Members.Board of Trustees. The Board of Trustees is required to have not fewer than 26 nor more than 65members. Trustees are selected on the basis of their expertise and experience in a variety of areas beneficial to the<strong>Cleveland</strong> <strong>Clinic</strong> and the <strong>Health</strong> <strong>System</strong> and are not <strong>com</strong>pensated for their services. A majority of the Trustees isrequired to be <strong>com</strong>prised of persons who meet each of the following criteria: (1) a citizen of Ohio; (2) a Member ofthe <strong>Cleveland</strong> <strong>Clinic</strong>; and (3) not a member of the Professional Staff. A Trustee is retired from active service as aTrustee, and the office deemed vacant, and his or her status is changed to Emeritus Trustee, at the annual meetingnext following the Trustee’s 72 nd birthday. Emeritus Trustees may hold the office for life and serve on Board<strong>com</strong>mittees, but have no voting rights. At present, there are 58 voting members of the Board of Trustees and 28Emeritus Trustees. The <strong>com</strong>position of the Board of Trustees is established in the Code of Regulations as follows:eight seats must be held by members of the Professional Staff, five must be members of the Board of Trustees ofCCHS-Western Region, one must be the Chairman of the Board of Trustees of Lakewood, and one must be theChairman of the Board of Trustees of Children’s Hospital. Each member of the Board of Trustees is elected for afive-year term, with the exception of Professional Staff members and Trustees from CCHS-Western Region,Lakewood and Children’s Hospital, all of whom are elected for one-year terms. Trustees may be re-elected at theexpiration of their respective terms of office.The Board of Trustees generally meets four times per year, including an annual meeting during which the<strong>Cleveland</strong> <strong>Clinic</strong>’s officers are elected and standing <strong>com</strong>mittees are appointed. The Trustees are responsible for allof the <strong>Cleveland</strong> <strong>Clinic</strong>’s operations and affairs and the control of its property, except as provided by law orotherwise delegated to the Board of Governors by the Code of Regulations. The Board of Trustees annuallyappoints certain <strong>com</strong>mittees to perform duties that it delegates to them from time to time. In addition, the Trusteesannually appoint an Executive Committee that subject to the control and direction of the Trustees, generallyoversees the operations and financial affairs of the <strong>Cleveland</strong> <strong>Clinic</strong> and the <strong>Health</strong> <strong>System</strong> during intervals betweenmeetings of the Board of Trustees. The Executive Committee is required to have at least eight members. At present,it has 21 members.The other <strong>com</strong>mittees of the Board of Trustees are: Audit, Buildings and Grounds, Compensation, Conflictof Interest, Development, Emerging Businesses, Finance, Governance, Government Relations, Investment,Marketing, and Research and Education.The Audit Committee of the Board of Trustees, pursuant to the Audit Committee Charter, reviews andapproves the external and internal audit plans and results, approves audit and non-audit accounting services, internalcontrols and regulatory and financial <strong>com</strong>pliance. Although the Audit Committee is only required to meet quarterly,it typically meets more frequently and is scheduled at present to meet seven times in 2008. Currently, the AuditCommittee has eight members, none of whom are employees of the <strong>Health</strong> <strong>System</strong>. The Audit Committee regularlyreports to the Board of Trustees.The Conflict of Interest Committee of the Board of Trustees is responsible for reviewing and resolving anypotential conflicts of interest in accordance with applicable legal requirements and the <strong>Cleveland</strong> <strong>Clinic</strong>’s conflict ofinterest policies. Trustees must disclose to the Conflict of Interest Committee any potential conflicts of interestA-5
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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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Changes in Net AssetsNet AssetsTemp
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Cleveland Clinic Health SystemNotes
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Other Financial Information
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• Ernst & Young LLPSuite 1300925
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Liabilities and net assetsCurrent l
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Liabilities and net assetsCurrent l
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Cleveland Clinic Health SystemConso
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Cleveland Clinic Health SystemConso
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Cleveland Clinic Health SystemNotes
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APPENDIX CSUMMARY OF BASIC DOCUMENT
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APPENDIX CSUMMARY OF BASIC DOCUMENT
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“Bond Indenture” means the Bond
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period of three months from the com
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PROPERTY”, and all improvements,
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direct, express or charitable trust
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Rate Hedge” for purposes of this
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Debt according to a fixed schedule
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“Officer’s Certificate” means
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provided, however, that Series 2008
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(t) liens on money or obligations d
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Project Administrator. In the event
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“Stated Maturity” means, when u
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(b) the Cleveland Clinic, or if the
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(d) the Master Trustee receives an
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(g) the loan of cash or other non-O
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under this caption shall be deemed
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Supplemental Indenture to which suc
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emedy thereunder, unless the Noteho
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purchase or other acquisition or re
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limitation, (A) the Special Funds a
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(b) Default in the payment of the p
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Fund Requirements, in the order of
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(g) to evidence the appointment of
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THE LEASEThe Lease contains various
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(a) Failure by the Cleveland Clinic
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APPENDIX DPROPOSED FORM OF OPINION
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PROPOSED TEXT OF LEGAL OPINION OFSQ
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October __, 2008Page 32008A Bonds c