Cleveland Clinic Health System Obligated Group - FMSbonds.com

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TOTAL OBLIGATED GROUPUtilization StatisticsSix Months EndedYear Ended December 31, June 30,2005 * 2006 * 2007 2007 2008Available Beds (1) 2,893 2,948 2,970 2,966 3,036Percent Occupancy (1) 76.1% 76.4% 76.9% 75.2% 75.1%Inpatient Admissions (1) 141,948 142,926 142,255 71,687 72,391Patient Days (1) 796,504 806,327 819,168 405,901 411,623Surgical Cases - Inpatient 49,671 48,854 50,272 26,018 25,963- Outpatient 103,035 102,427 103,155 52,003 51,425- Total 152,706 151,281 153,427 78,021 77,388Emergency Room Visits 352,087 350,109 343,628 163,611 162,125(1)Acute and non-acute, including rehabilitative and psychiatric services within non-acute, but excluding newborns and bassinets..(*) Restated to exclude 2005 and 2006 data for the operation of Naples Hospital by CCF Florida Hospital Corporation, which is no longer amember of the Obligated Group.F. PROFESSIONAL STAFFThe Cleveland Clinic and Florida Clinic. The Cleveland Clinic and Florida Clinic are relatively uniquein that they directly employ members of their respective Professional Staffs. The Cleveland Clinic employsapproximately 2,100 Professional Staff members, of whom approximately 1,800 are physicians with privileges topractice at the main campus Hospital, and Florida Clinic employs approximately 150 Professional Staff members.Members of the respective Professional Staffs are employed upon approval by an Institute or medical divisioncommittee and appointment by the Board of Governors (or in the case of Florida Clinic, the Board of Trustees ofFlorida Clinic). Those physician members of the Professional Staff are separately credentialed pursuant to theCleveland Clinic or Weston Hospital Medical Staff Bylaws. Patient care is the first priority for a Professional Staffmember. Attending physicians are responsible for the overall management of their patients’ care, for evaluation andtreatment of those patients while on site and for direct liaison with support services and referring outside physiciansuntil such time as those responsibilities are transferred to another physician.Professional Staff members are expected to participate in educational activities consistent withdepartmental and Cleveland Clinic Health System needs. They are also encouraged to undertake research projectswith the approval of their department or Institute chairman.The average age of the Cleveland Clinic’s Professional Staff is approximately 46 years, and the averagelength of service at the Cleveland Clinic is approximately nine years. The average age of Florida Clinic’sProfessional Staff is approximately 44 years, and the average length of service at Florida Clinic is approximately sixyears.The opportunity to specialize, the ability to participate in medical education and research, the high level ofpatient care practice and the opportunity for professional associations continue to enable the Cleveland Clinic andFlorida Clinic to attract highly qualified physicians. Selection is based on prior professional training and experiencein a particular field, professional society activities, previous teaching and research experience or interest, and thecandidate’s documented expertise in the area of specialization.Other Obligated Group Members. Members of the Obligated Group other than the Cleveland Clinic andFlorida Clinic have medical staffs of the following approximate sizes: CCHS-East Region – 2,019,Fairview/Lutheran - 994 and Marymount - 577. Physicians appointed to the medical staffs of these members of theObligated Group enjoy hospital admitting privileges, but in most instances are not employees of the respectivemember of the Obligated Group.A-20
Statistical Information. The following table sets forth current medical staff allocations for the ClevelandClinic and each of the other members of the Obligated Group:OBLIGATED GROUPMedical Staff AllocationsMedical Staff (1)ClevelandClinicCCHS-EastRegionFairview/LutheranMarymountFloridaClinicPrimary CareFamily Practice 46 110 85 30 6Pediatrics 59 177 112 54 0Obstetrics/Gynecology 59 50 62 24 0Internal Medicine 156 309 93 54 14Total Primary Care 320 646 352 162 20Medical SpecialtiesCardiology 104 64 53 9 10Dermatology 27 21 13 6 4Gastroenterology 40 44 11 10 6Hematology Oncology 39 32 11 11 3Infectious Disease 19 28 10 10 1Neurology 55 25 7 7 6Psychology/Psychiatry 54 51 45 20 0Pulmonary 33 35 7 5 4Other 182 130 85 27 28Total Medical Specialties 553 430 242 105 62Surgical SpecialtiesColorectal 18 8 1 3 4General Surgery 43 54 21 22 4Neurological Surgery 35 19 17 3 2Orthopaedics 53 66 34 25 7Otolaryngology 30 24 15 11 2Cardiological Surgery 41 12 7 3 2Urology 53 47 8 19 6Vascular Surgery 16 20 4 6 2Other 12 152 92 29 9Total Surgical Specialties 301 402 199 121 38OthersPathology 51 32 9 8 2Anesthesiology 184 47 36 19 14Radiology 198 291 134 135 10Ophthalmology 54 39 22 12 2Research (2) 288 18 0 0 0Other 151 114 0 15 0Total Others 926 541 201 189 28Total 2,100 2,019 994 577 148(1)(2)Certain physicians have admitting privileges at more than one of the members of the Obligated Group, with the result that aphysician may be counted more than once in this table.The members of the Obligated Group (other than the Cleveland Clinic) do not employ full time research scientists. Physicians withstaff privileges at the hospital facilities of these Obligated Group members may perform clinical research pursuant to therequirements of the applicable institution’s Institutional Review Board.A-21
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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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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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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: E. UTILIZATIONThe following tables
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
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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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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
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