TY 2020 Form 990 Schedule O

Instrumentl eFile RenderObject ID: 202143159349301799 - Rendered 2024-04-27 TIN: 34-0714585

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Return Reference	Explanation
FORM 990, PART III, PROGRAM SERVICE STATEMENT	CLEVELAND CLINIC, HEADQUARTERED IN CLEVELAND, OHIO, IS A NONPROFIT, TAX-EXEMPT ACADEMIC MEDICAL CENTER THAT INTEGRATES CLINICAL AND HOSPITAL CARE WITH RESEARCH AND EDUCATION. THE CLEVELAND CLINIC FOUNDATION IS THE PARENT OF THE CLEVELAND CLINIC HEALTH SYSTEM. CLEVELAND CLINIC WAS ESTABLISHED IN 1921. IN JANUARY 2021 AS THE CLINIC CELEBRATED ITS CENTENNIAL YEAR A NEW MISSION STATEMENT WAS UNVEILED: CARING FOR LIFE, RESEARCHING FOR HEALTH AND EDUCATING THOSE WHO SERVE. THE NEW MISSION STATEMENT STAYS TRUE TO THE PAST, ENCOMPASSES THE PRESENT AND OUTLINES THE FUTURE OF THE ORGANIZATION. 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 HEALTH SYSTEM 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 2020 CLEVELAND CLINIC AND ITS AFFILIATES PROVIDED $1.3 BILLION 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 AT CLEVELANDCLINIC.ORG. (COMMUNITY BENEFIT AMOUNTS REPORTED IN THIS PROGRAM SERVICE STATEMENT REFER TO THE CLEVELAND CLINIC'S 2020 COMMUNITY CONNECTIONS, BASED ON THE CHA REPORTING METHODOLOGY. SEE FORM 990, SCHEDULE H FOR A RECONCILIATION OF SCHEDULE H TO COMMUNITY BENEFIT REPORTING.) COVID-19 ON MARCH 11, 2020, THE WORLD HEALTH ORGANIZATION DECLARED THE NOVEL CORONAVIRUS DISEASE (COVID-19) OUTBREAK A GLOBAL PANDEMIC. THE GOVERNORS OF OHIO AND FLORIDA DECLARED A STATE OF EMERGENCY FOR THEIR RESPECTIVE STATES RELATED TO THE COVID-19 OUTBREAK ON MARCH 9, 2020, AND A NATIONAL STATE OF EMERGENCY IN THE U.S. WAS DECLARED ON MARCH 13, 2020. THE SYSTEM IS WORKING WITH PUBLIC HEALTH PARTNERS AT ALL LEVELS TO MAINTAIN THE HEALTH AND SAFETY OF PATIENTS, VISITORS AND CAREGIVERS TO PREVENT THE SPREAD OF COVID-19. THE SYSTEM IS ALSO PROVIDING EXTENSIVE EDUCATION TO PATIENTS ON THE PRECAUTIONS THAT HAVE BEEN IMPLEMENTED TO KEEP PATIENTS AND CAREGIVERS SAFE DURING THEIR APPOINTMENTS AND PROCEDURES. THROUGHOUT THE PANDEMIC THE SYSTEM HAS REMAINED FOCUSED ON CREATING A SAFE ENVIRONMENT FOR PATIENTS AND CAREGIVERS TO ENSURE THE AVAILABILITY OF CARE FOR EARLY IDENTIFICATION OF DISEASES AND HELPING PATIENTS IN MANAGING CHRONIC DISEASES. SINCE THE BEGINNING OF THE PANDEMIC, THE SYSTEM HAS PROVIDED CARE TO MORE THAN 20,000 COVID-19 PATIENTS ADMITTED TO ITS OHIO AND FLORIDA FACILITIES. IN OHIO, THE SYSTEM HAS CARED FOR APPROXIMATELY 25% OF ALL PATIENTS HOSPITALIZED WITH COVID-19. DURING THE EARLY PHASE OF THE PANDEMIC, THE SYSTEM ESTABLISHED TESTING SITES IN ITS COMMUNITIES TO HELP SLOW THE SPREAD OF COVID-19. THE SYSTEM WAS ONE OF THE FIRST HEALTH SYSTEMS TO OFFER COVID-19 TESTING WHEN THE PANDEMIC BEGAN AND HAS PERFORMED MORE THAN ONE MILLION TESTS IN ITS LABORATORIES IN OHIO AND FLORIDA. I. PATIENT CARE IN 2020, THE CLEVELAND CLINIC HEALTH SYSTEM INCLUDES 18 HOSPITALS; THIRTEEN OF THE HOSPITALS ARE OPERATED IN THE NORTHEAST OHIO AREA, ANCHORED BY THE CLINIC. CLEVELAND CLINIC OPERATES 21 OUTPATIENT FAMILY HEALTH CENTERS, AND 11 AMBULATORY SURGERY CENTERS, AS WELL AS NUMEROUS PHYSICIAN OFFICES, WHICH ARE LOCATED THROUGHOUT NORTHEAST OHIO. IN FLORIDA, THE CLEVELAND CLINIC HEALTH SYSTEM OPERATES FIVE HOSPITALS AND A CLINIC LOCATED THROUGHOUT SOUTHEAST FLORIDA, OUTPATIENT FAMILY HEALTH CENTERS IN WEST PALM BEACH AND PORT ST. LUCIE, AN OUTPATIENT FAMILY HEALTH AND AMBULATORY SURGERY CENTER IN CORAL SPRINGS, AND NUMEROUS PHYSICIAN OFFICES LOCATED THROUGHOUT SOUTHEAST FLORIDA. IN ADDITION, THE CLEVELAND CLINIC HEALTH SYSTEM OPERATES A HEALTH AND WELLNESS CENTER AND A SPORTS MEDICINE CLINIC IN TORONTO, CANADA, AND A SPECIALIZED NEUROLOGICAL CLINICAL CENTER IN LAS VEGAS, NEVADA. THE CLEVELAND CLINIC HEALTH SYSTEM ALSO PROVIDES CARE AT CLEVELAND CLINIC ABU DHABI; A MULTISPECIALTY HOSPITAL OFFERING CRITICAL AND ACUTE CARE SERVICES THAT IS PART OF MUBADALA DEVELOPMENT COMPANY'S NETWORK OF HEALTHCARE FACILITIES LOCATED IN ABU DHABI, UNITED ARAB EMIRATES. CLEVELAND CLINIC ABU DHABI'S CANCER TREATMENT IS MODELED AFTER THE CLINIC'S TAUSSIG CANCER CENTER AND EXPANDS THE RANGE OF CANCER TREATMENTS AVAILABLE WITH CENTRALIZED ONCOLOGY SERVICES PROVIDING DEDICATED CLINICAL PRACTICE AREAS FOR ADVANCED IMAGING, INFUSION, RADIATION, AND CHEMOTHERAPY, AS WELL AS A CONNECTION TO THE HOSPITAL'S SURGICAL AREAS. CLEVELAND CLINIC HEALTH SYSTEM IS DEDICATED TO THE COMMUNITIES IT SERVES 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 ITS FINANCIAL ASSISTANCE EFFORTS AND AS A LEADING MEDICAID PROVIDER IN OHIO, CLEVELAND CLINIC PROVIDES HEALTHCARE TO THOSE WHO OTHERWISE COULD NOT AFFORD IT. IN 2020, CLEVELAND CLINIC RECORDED 1,276 TOTAL STAFFED BEDS, 106,587 EMERGENCY VISITS, 68,590 SURGICAL CASES, 48,776 ADMISSIONS, AND MORE THAN 8.7 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 & PAIN MANAGEMENT; CANCER CENTER/TAUSSIG CANCER; CHILDREN'S & PEDIATRIC; COMMUNITY CARE; DERMATOLOGY & PLASTIC SURGERY; DIGESTIVE DISEASE & SURGERY; EMERGENCY SERVICES; ENDOCRINOLOGY & METABOLISM; COLE EYE; GENOMICS; HEAD & NECK; HEART, VASCULAR & THORACIC; IMAGING; NEUROLOGICAL; NURSING; OB/GYN & WOMEN'S HEALTH; ORTHOPAEDIC & RHEUMATOLOGIC; PATHOLOGY & LABORATORY MEDICINE; RESPIRATORY; AND UROLOGY & KIDNEY. NOTABLE ACHIEVEMENTS CLEVELAND CLINIC WAS AGAIN RECOGNIZED FOR ITS QUALITY OF CARE IN U.S. NEWS & WORLD REPORT'S PRESTIGIOUS ANNUAL AMERICA'S BEST HOSPITALS SURVEY IN 2020. OVERALL, CLEVELAND CLINIC WAS AMONG THE NATION'S BEST HOSPITALS, EARNING THE NO. 2 RANKING. FOR THE 26TH CONSECUTIVE YEAR, CLEVELAND CLINIC RANKED BEST IN THE NATION FOR CARDIOLOGY AND HEART SURGERY, EARNING THE NO. 1 SPOT. 13 CLEVELAND CLINIC SPECIALTIES ALSO RANKED IN THE TOP 10. OF THESE, NINE PLACED IN THE TOP 5 INCLUDING: CARDIOLOGY & HEART SURGERY; UROLOGY; GASTROENTEROLOGY AND GASTROINTESTINAL SURGERY; NEPHROLOGY; RHEUMATOLOGY; PULMONOLOGY AND LUNG SURGERY; CANCER; GERIATRICS AND GYNECOLOGY. CLEVELAND CLINIC WAS NATIONALLY RANKED IN 14 ADULT SPECIALTIES AND 10 CHILDREN'S SPECIALTIES. CLEVELAND CLINIC WAS ALSO RATED HIGH PERFORMING IN NINE PROCEDURES AND CONDITIONS. CLEVELAND CLINIC HAS ACHIEVED THE DISTINGUISHED MAGNET RECOGNITION. MAGNET STATUS IS THE HIGHEST NATIONAL RECOGNITION AWARDED TO A HOSPITAL OR MEDICAL CENTER FOR EXCELLENCE IN NURSING. ANCC, A SUBSIDIARY OF THE AMERICAN NURSES ASSOCIATION, GRANTS MAGNET STATUS WHEN A HEALTHCARE ORGANIZATION REFLECTS NURSING PROFESSIONALISM, TEAMWORK AND SUPERIORITY IN PATIENT CARE. FEWER THAN 400 OF THE COUNTRY'S 6,000-PLUS HOSPITALS HAVE EARNED THIS PRESTIGIOUS HONOR.
FORM 990, PART III, PROGRAM SERVICE STATEMENT (CONTINUED)	FOR THE TENTH TIME IN THE PAST 12 YEARS, CLEVELAND CLINIC HAS BEEN RECOGNIZED AS ONE OF THE WORLD'S MOST ETHICAL COMPANIES. CLEVELAND CLINIC IS ONE OF JUST FIVE HEALTHCARE PROVIDERS WORLDWIDE ON THE 2020 LIST BY THE ETHISPHERE INSTITUTE, WHICH DESCRIBES ITSELF AS "ADVANCING THE STANDARDS OF ETHICAL BUSINESS PRACTICES THAT FUEL CORPORATE CHARACTER, MARKETPLACE TRUST AND BUSINESS SUCCESS." CLEVELAND CLINIC RECEIVED SEVERAL AWARDS FROM PRACTICE GREENHEALTH. PRACTICE GREENHEALTH RECOGNIZES ORGANIZATIONS WITHIN THE HEALTHCARE SECTOR THAT SUPPORT AND CREATE BETTER, SAFER, AND GREENER WORKPLACES AND COMMUNITIES. IN 2020, CLEVELAND CLINIC AND ITS FACILITIES RECEIVED: THE ENVIRONMENTAL EXCELLENCE AWARD, GREENING THE OR AWARD, EEP (ENVIRONMENTALLY PREFERABLE PURCHASING) CIRCLE AWARD, CLIMATE CIRCLE AWARD, GREEN BUILDING CIRCLE AWARD, GREENHEALTH EMERALD AWARD, GREENHEALTH PARTNER FOR CHANGE AWARD, SYSTEM FOR CHANGE AWARD AND PARTNER RECOGNITION AWARD. FINANCIAL ASSISTANCE THE CLEVELAND CLINIC FINANCIAL ASSISTANCE POLICY ASSISTS POOR AND INDIGENT PATIENTS BY PROVIDING FREE CARE FOR EMERGENCY AND MEDICALLY NECESSARY SERVICES TO UNINSURED PATIENTS WITH INCOMES UP TO 250 PERCENT OF THE FEDERAL POVERTY LEVEL AND ALSO OFFERS DISCOUNTS ON EMERGENCY AND MEDICALLY NECESSARY SERVICES FOR UNINSURED PATIENTS WHOSE INCOME IS UP TO 400 PERCENT OF THE POVERTY LEVEL. PATIENTS WITH SPECIAL MEDICAL OR EXCEPTIONAL CIRCUMSTANCES MAY ALSO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY IS DESIGNED TO PREVENT MEDICAL BILLS FROM CAUSING A PATIENT OR FAMILY UNDUE FINANCIAL HARDSHIP. THE CLEVELAND CLINIC HEALTH SYSTEM PROVIDED FINANCIAL ASSISTANCE AT A COST OF $184.5 MILLION IN 2020. 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. 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. 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 200 FACULTY-LEVEL SCIENTISTS ORGANIZED IN THE FOLLOWING DEPARTMENTS: BIOMEDICAL ENGINEERING, CANCER BIOLOGY, CARDIOVASCULAR AND METABOLIC SCIENCES, GENOMIC MEDICINE, IMMUNOTHERAPY & PRECISION IMMUNO-ONCOLOGY, INFLAMMATION AND IMMUNITY, NEUROSCIENCES, OPHTHALMIC RESEARCH, QUANTITATIVE HEALTH SCIENCES, 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 238 RESEARCH FELLOWS, 113 GRADUATE STUDENTS AND 18 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 2020, CLEVELAND CLINIC WAS INVOLVED IN APPROXIMATELY 2,700 ACTIVE INSTITUTIONAL REVIEW BOARD APPROVED 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 2020, CLEVELAND CLINIC PROVIDED COMMUNITY BENEFIT IN RESEARCH AT A SUBSIDIZED COST OF MORE THAN $261.8 MILLION, WHICH INCLUDED EXTERNALLY- SPONSORED FUNDING OF $159.8 MILLION. 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 THE 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 2020, PROVIDED A NET COMMUNITY BENEFIT OF $309.7 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 2020, 1,045 RESIDENTS AND FELLOWS TRAINED IN 81 ACCREDITED TRAINING PROGRAMS, APPROVED BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME), INCLUDING 136 ADVANCED FELLOWS IN 80 FELLOWSHIP PROGRAMS. -LERNER COLLEGE OF MEDICINE: SINCE ITS INCEPTION IN MAY 2002, THE LERNER COLLEGE OF MEDICINE HAS LINKED ONE OF THE NATION'S TOP HOSPITALS WITH ONE OF THE NATION'S LEADING RESEARCH UNIVERSITIES. THERE WERE 1,849 APPLICANTS FOR 32 POSITIONS FOR THE 2020-21 ACADEMIC YEAR. THE PROGRAM'S STUDENTS HAVE MATCHED AT SOME OF THE MOST PRESTIGIOUS HOSPITALS THROUGHOUT THE UNITED STATES AND HAVE CONTRIBUTED 173 PUBLICATIONS TO THE WORLD'S STORE OF SCIENTIFIC KNOWLEDGE BASED ON 2020 CALENDAR YEAR (WHICH INCLUDES PUBLISHED ARTICLES AND ABSTRACT SUBMISSIONS), AND 46 STUDENTS PARTICIPATED IN LOCAL AND NATIONAL MEETINGS WITH PRESENTATIONS AND POSTERS. -VISITING MEDICAL STUDENTS: VISITING MEDICAL STUDENT EDUCATION REPRESENTS A MAJOR ACADEMIC COMMITMENT BY CLEVELAND CLINIC. IN 2020, 51 MEDICAL STUDENTS FROM 22 MEDICAL SCHOOLS AROUND THE WORLD ROTATED THROUGH CLEVELAND CLINIC. -CENTER FOR CONTINUING EDUCATION: CLEVELAND CLINIC MAINTAINS ONE OF THE LARGEST CONTINUING MEDICAL EDUCATION (CME) PROGRAMS IN THE COUNTRY AND ENJOYS THE HIGHEST ACCME RANKING: ACCREDITATION WITH COMMENDATION. IN 2020, THE CENTER FOR CONTINUING EDUCATION CERTIFIED 1,553 CME ACTIVITIES THAT OFFERED OVER 10,180 CME CREDITS TO 341,858 PARTICIPANTS. OF THAT NUMBER, 1,015 WERE LIVE COURSES THAT ATTRACTED 187,194 PARTICIPANTS. CLEVELAND CLINIC IS ONE OF THE LARGEST PROVIDERS OF ONLINE CME AMONG THE NATION'S ACADEMIC MEDICAL CENTERS. THE CENTER'S WEBSITE HAD 527 ACTIVITIES THAT ATTRACTED 198,751 ACTIVITY VIEWERS. JOURNAL CME CONTINUES TO REACH A LARGE NUMBER OF LEARNERS, AWARDING MORE THAN 63,291 CERTIFICATES TO CLEVELAND CLINIC JOURNAL OF MEDICINE (CCJM) PARTICIPANTS. IN 2020, THE CENTER ISSUED 324,793 CERTIFICATES FOR ALL ACTIVITIES COMBINED. -THE CCJM ENJOYED A CIRCULATION OF MORE THAN 128,583 COPIES AND RANKED NO. 3 IN READERSHIP AMONG JOURNALS DIRECTED TO OFFICE-BASED INTERNISTS AND CARDIOLOGISTS. EACH YEAR, THE PRINT AND ONLINE VERSIONS ARE READ OR ACCESSED BY APPROXIMATELY 7.1 MILLION PEOPLE AROUND THE WORLD. IN 2020 THE CCJM WEBSITE RECORDED 12,561,060 PAGE VIEWS FROM 9,554,530 UNIQUE VISITORS. -CENTER FOR HEALTH SCIENCES EDUCATION: CLEVELAND CLINIC IS A MAJOR EDUCATION AND TRAINING SITE FOR A NUMBER OF ALLIED HEALTH STUDENTS FROM VARIOUS ACADEMIC PROGRAMS THROUGHOUT THE REGION. THE CLEVELAND CLINIC HEALTH SYSTEM CURRENTLY OFFERS 8 IN-HOUSE ALLIED HEALTH PROGRAMS AND HAS 35 AFFILIATED PROGRAMS WITH REGIONAL ACADEMIC INSTITUTIONS. IN 2020, CLEVELAND CLINIC HEALTH SYSTEM HOSTED MORE THAN 318,848 CLINICAL ROTATION HOURS FOR OVER 892 HEALTH SCIENCE STUDENTS. -CENTER FOR INTERNATIONAL MEDICAL EDUCATION: THE CENTER FOR INTERNATIONAL MEDICAL EDUCATION (CIME) IS RESPONSIBLE FOR COORDINATING CLEVELAND CLINIC'S INTERNATIONAL EDUCATIONAL INITIATIVES AND FOR ENSURING THE PROVISION OF HIGH QUALITY EDUCATIONAL EXPERIENCES FOR THE GLOBAL MEDICAL COMMUNITY. IN 2020, 103 INTERNATIONAL PHYSICIANS AND MEDICAL STUDENTS TRAVELED TO CLEVELAND CLINIC TO PARTICIPATE IN OBSERVERSHIPS; AND STAFF TRAVELED TO 2 COUNTRIES TO SHARE CLINICAL AND SURGICAL INNOVATIONS.
FORM 990, PART III, PROGRAM SERVICE STATEMENT (CONTINUED)	IV. ADDITIONAL COMMUNITY BENEFIT PATIENT CARE PROVIDED ON A CHARITABLE BASIS, RESEARCH, AND EDUCATION DESCRIBED ABOVE ARE INTEGRAL COMPONENTS OF THE COMMUNITY BENEFIT THE CLEVELAND CLINIC HEALTH SYSTEM ANNUALLY REPORTS TO THE COMMUNITY. THE OTHER COMPONENTS OF THE CLEVELAND CLINIC'S COMMUNITY BENEFIT ARE: 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 2020, THE HEALTH SYSTEM'S UNPAID MEDICAID COSTS WERE $537.6 MILLION (THIS FIGURE IS NET OF AN HCAP BENEFIT OF $13.8 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 2020 AT A COST OF $34.4 MILLION. COMMUNITY OUTREACH PROGRAMS THE CLEVELAND CLINIC HEALTH SYSTEM IS ACTIVELY ENGAGED IN A BROAD ARRAY OF COMMUNITY OUTREACH PROGRAMS, PROVIDING OR CONTRIBUTING TO OUTREACH ACTIVITIES FOR A TOTAL NET COMMUNITY BENEFIT OF $127.4 MILLION, PARTIALLY OFFSET BY EXTERNAL FUNDING. THESE PROGRAMS ARE DESIGNED TO SERVE THE VULNERABLE AND AT-RISK POPULATIONS, AS WELL AS BROADER POPULATION IN OUR COMMUNITIES. OUR RESPONSIVE OUTREACH PROGRAMS RANGE FROM FREE WELLNESS INITIATIVES, HEALTH SCREENINGS, CLINICAL SERVICES, EDUCATION, AND YOUTH WORKFORCE DEVELOPMENT TO ENROLLMENT ASSISTANCE FOR GOVERNMENT-FUNDED HEALTH PROGRAMS. OUTREACH PROGRAMS ADDRESS DOCUMENTED HEALTH NEEDS OF OUR COMMUNITIES, ALIGN WITH OUR COMMUNITY HEALTH NEEDS ASSESSMENTS AND FALL INTO THREE MAIN CATEGORIES: COMMUNITY HEALTH SERVICES, CASH AND IN-KIND DONATIONS, AND COMMUNITY BUILDING. IN 2020, SOME HIGHLIGHTS INCLUDED: -COMMUNITY HEALTH EDUCATION AND CLINICAL SERVICES FOR COMMUNITY RESIDENTS ON COVID-19 REGARDING VIRUS IMPACT, TESTING AND VACCINE DISTRIBUTION IN LOCAL NEIGHBORHOODS. INCLUDED PARTNERSHIPS WITH HEALTH DEPARTMENTS AND COMMUNITY BASED ORGANIZATIONS. -FAITH BASED FORUMS FOR KEY COMMUNITY LEADERS ON COVID-19 EDUCATION AND ACCESS. -WELLNESS INITIATIVES TO RESIDENTS, SCHOOLS AND COMMUNITY BASED ORGANIZATIONS IN THE AREAS OF DISEASE PREVENTION, INCLUDING COVID-19 PROTOCOL, PERSONAL SAFETY, BEHAVIORAL HEALTH, STRESS MANAGEMENT, NUTRITION IMPROVEMENT AND EXERCISE. -HIGH-SPEED INTERNET ACCESS TO LOCAL COMMUNITY IN EFFORTS TO INCREASE RESIDENTS' ABILITY TO ATTEND VIRTUAL VISITS, SCHOOLS AND COMMUNITY FORUMS. -DONATIONS OF FOOD AND PERSONAL PROTECTIVE EQUIPMENT TO COMMUNITY BASED ORGANIZATIONS. -COMMUNITY FARMERS MARKETS, URBAN GARDENS AND A MOBILE FOOD PANTRY PROVIDED ACCESS TO FRESH LOCAL PRODUCTS AND SUPPLEMENTAL FOOD PROGRAMS TO ADDRESS FOOD INSECURITY ISSUES. -CLEVELAND CLINIC PROVIDED NO-COST CLINICAL CARE TO UNDER- AND UNINSURED FAMILIES AT COMMUNITY SITES, INCLUDING LANGSTON HUGHES HEALTH & EDUCATION CENTER IN FAIRFAX NEIGHBORHOOD. CARE INCLUDES MULTIGENERATIONAL WELLNESS CLASSES, CANCER SCREENING AND CHRONIC DISEASE MANAGEMENT SERVICES. -COLLABORATIVE INITIATIVES WITH COMMUNITY NONPROFIT ORGANIZATIONS AND LOCAL GOVERNMENTS ADDRESSED CRITICAL POPULATION ISSUES. TASKFORCE STRATEGIES FOCUSED ON DECREASING OPIOID PRESCRIPTIONS USE AND OVERDOSE DEATHS. HOSPITALS AND COUNTIES PROVIDED METHODS TO DECREASE INFANT MORTALITY INCLUDING PROACTIVE CENTERING PROGRAMS. -WORKFORCE DEVELOPMENT PROGRAMS TO MIDDLE SCHOOL AND HIGH SCHOOL STUDENTS TO ENHANCE GRADUATION RATES, PURSUE SECONDARY EDUCATION AND OBTAIN EMPLOYMENT. 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.
FORM 990, PART VI, SECTION A, LINE 2	DEBORAH CRAWFORD, CCF DIRECTOR & PATRICK AULETTA, CCF DIRECTOR - BUSINESS
FORM 990, PART VI, SECTION A, LINE 3	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 CLEVELAND CLINIC FOUNDATION ENTERED INTO A MANAGEMENT AGREEMENT WITH KESSLER REHABILITATION SERVICES, INC. AS PART OF A JOINT VENTURE WITH HOSPITAL HOLDINGS CORPORATION (SELECT MEDICAL") TO MANAGE AND OPERATE THREE INPATIENT REHABILITATION HOSPITAL FACILITIES. THE CLEVELAND CLINIC FOUNDATION ENTERED INTO A MANAGEMENT AGREEMENT WITH REGENCY HOSPITALS, LLC AS PART OF A JOINT VENTURE WITH SELECT UNIT MANAGEMENT, INC. (SELECT MEDICAL") TO MANAGE AND OPERATE FOUR LONG TERM ACUTE CARE FACILITIES.
FORM 990, PART VI, SECTION A, LINE 6	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 DIRECTORS. IT DOES NOT HAVE STOCKHOLDERS.
FORM 990, PART VI, SECTION A, LINE 7A	PURSUANT TO NONPROFIT CORPORATION LAW, THE "MEMBERS" OF THE CORPORATION ELECT THE BOARD OF DIRECTORS OR BOARD OF 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.
FORM 990, PART VI, SECTION A, LINE 7B	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.
FORM 990, PART VI, SECTION B, LINE 11B	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, AND MEMBERS OF THE AUDIT COMMITTEE. 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. THE FINAL E-FILED RETURN WILL BE POSTED ON THE ORGANIZATION'S WEBSITE AT WWW.CLEVELANDCLINIC.ORG.
FORM 990, PART VI, SECTION B, LINE 12C	BOARD MEMBERS AND OFFICERS OF CCF AND ITS SUBSIDIARIES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. THE DISCLOSURES ARE REVIEWED BY STAFF REPORTING TO THE CHIEF GOVERNANCE OFFICER AND ANY ITEMS THAT MAY CREATE A CONFLICT ARE BROUGHT TO HIS ATTENTION. IF THERE ANY DISCLOSURE CHANGES DURING THE YEAR OR A NEW DISCLOSURE, THE POLICY REQUIRES THAT THOSE INDIVIDUALS INFORM THE CHIEF GOVERNANCE OFFICER. THE BOARD OF DIRECTORS CONFLICT OF INTEREST AND MANAGING INNOVATIONS COMMITTEE MEETS FOUR TIMES PER YEAR AND REVIEWS THE DISCLOSURES, ANY PROPOSED ARRANGEMENTS THAT MAY INVOLVE A POTENTIAL CONFLICT OF INTEREST, AND DOCUMENTS ITS 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 THE FINAL CONSIDERATION OR VOTING ON THE ARRANGEMENTS.
FORM 990, PART VI, SECTION B, LINE 15	ALL CCF OFFICERS AND SIGNIFICANT MANAGEMENT EXECUTIVE 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, 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 SIGNIFICANT MANAGEMENT EXECUTIVE 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.
FORM 990, PART VI, SECTION C, LINE 18	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.
FORM 990, PART VI, SECTION C, LINE 19	CCF 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.
FORM 990, PART VIII, LINE 1E	THE SYSTEM HAS RECEIVED SUPPORT UNDER THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT, INCLUDING PROVIDER RELIEF FUNDS (PRF) AND THE EMPLOYEE RETENTION CREDIT (ERC). THE SYSTEM ACCOUNTED FOR BOTH THE PRF PAYMENTS AND ERC AS CONTRIBUTIONS THAT ARE RECOGNIZED AS REVENUE WHEN ANY RELATED CONDITIONS HAVE BEEN SUBSTANTIALLY MET. THE PRF PROVIDES FUNDING FROM THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) TO HEALTHCARE PROVIDERS TO SUPPORT HEALTHCARE-RELATED EXPENSES OR LOST REVENUE ATTRIBUTABLE TO COVID-19. FUNDS RECEIVED FROM THE PRF REPRESENT PAYMENTS TO PROVIDERS AND DO NOT NEED TO BE REPAID AS LONG AS THE SYSTEM COMPLIES WITH CERTAIN TERMS AND CONDITIONS IMPOSED BY HHS, INCLUDING REPORTING AND COMPLIANCE REQUIREMENTS. IN 2020, THE SYSTEM RECOGNIZED $359.2 MILLION OF PRF PAYMENTS IN OTHER UNRESTRICTED REVENUES BASED ON THE TERMS AND CONDITIONS OF THE PAYMENTS. $355 MILLION OF THE 359.2 MILLIONS IS INCLUDED ON LINE 1E. THE REMAINING $4.2 MILLION ARE ON THE SYSTEMS TAXABLE ENTITIES.
FORM 990, PART X, LINE 15	ALL SPLIT LOANS WERE REPAID OR FORGIVEN AS OF FEBRUARY 2020.
FORM 990, PART XI, LINE 9:	EQUITY TRANSFERS & OTHER TRANSFERS 610,211. GIFTS AND BEQUESTS 104,180,330. TRANSFERS OF NET ASSETS -29,809,173. NET INVESTMENT INCOME 72,478,725. NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS -45,956,097. RETIREMENT BENEFITS ADJUSTMENT -9,394,320. DONATED CAPITAL AND ASSETS RELEASED FROM RESTRICTIONS FOR CAPITAL PURPOSES 1,818,265.

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Explanation

FORM 990, PART III, PROGRAM SERVICE STATEMENT

CLEVELAND CLINIC, HEADQUARTERED IN CLEVELAND, OHIO, IS A NONPROFIT, TAX-EXEMPT ACADEMIC MEDICAL CENTER THAT INTEGRATES CLINICAL AND HOSPITAL CARE WITH RESEARCH AND EDUCATION. THE CLEVELAND CLINIC FOUNDATION IS THE PARENT OF THE CLEVELAND CLINIC HEALTH SYSTEM. CLEVELAND CLINIC WAS ESTABLISHED IN 1921. IN JANUARY 2021 AS THE CLINIC CELEBRATED ITS CENTENNIAL YEAR A NEW MISSION STATEMENT WAS UNVEILED: CARING FOR LIFE, RESEARCHING FOR HEALTH AND EDUCATING THOSE WHO SERVE. THE NEW MISSION STATEMENT STAYS TRUE TO THE PAST, ENCOMPASSES THE PRESENT AND OUTLINES THE FUTURE OF THE ORGANIZATION. 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 HEALTH SYSTEM 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 2020 CLEVELAND CLINIC AND ITS AFFILIATES PROVIDED $1.3 BILLION 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 AT CLEVELANDCLINIC.ORG. (COMMUNITY BENEFIT AMOUNTS REPORTED IN THIS PROGRAM SERVICE STATEMENT REFER TO THE CLEVELAND CLINIC'S 2020 COMMUNITY CONNECTIONS, BASED ON THE CHA REPORTING METHODOLOGY. SEE FORM 990, SCHEDULE H FOR A RECONCILIATION OF SCHEDULE H TO COMMUNITY BENEFIT REPORTING.) COVID-19 ON MARCH 11, 2020, THE WORLD HEALTH ORGANIZATION DECLARED THE NOVEL CORONAVIRUS DISEASE (COVID-19) OUTBREAK A GLOBAL PANDEMIC. THE GOVERNORS OF OHIO AND FLORIDA DECLARED A STATE OF EMERGENCY FOR THEIR RESPECTIVE STATES RELATED TO THE COVID-19 OUTBREAK ON MARCH 9, 2020, AND A NATIONAL STATE OF EMERGENCY IN THE U.S. WAS DECLARED ON MARCH 13, 2020. THE SYSTEM IS WORKING WITH PUBLIC HEALTH PARTNERS AT ALL LEVELS TO MAINTAIN THE HEALTH AND SAFETY OF PATIENTS, VISITORS AND CAREGIVERS TO PREVENT THE SPREAD OF COVID-19. THE SYSTEM IS ALSO PROVIDING EXTENSIVE EDUCATION TO PATIENTS ON THE PRECAUTIONS THAT HAVE BEEN IMPLEMENTED TO KEEP PATIENTS AND CAREGIVERS SAFE DURING THEIR APPOINTMENTS AND PROCEDURES. THROUGHOUT THE PANDEMIC THE SYSTEM HAS REMAINED FOCUSED ON CREATING A SAFE ENVIRONMENT FOR PATIENTS AND CAREGIVERS TO ENSURE THE AVAILABILITY OF CARE FOR EARLY IDENTIFICATION OF DISEASES AND HELPING PATIENTS IN MANAGING CHRONIC DISEASES. SINCE THE BEGINNING OF THE PANDEMIC, THE SYSTEM HAS PROVIDED CARE TO MORE THAN 20,000 COVID-19 PATIENTS ADMITTED TO ITS OHIO AND FLORIDA FACILITIES. IN OHIO, THE SYSTEM HAS CARED FOR APPROXIMATELY 25% OF ALL PATIENTS HOSPITALIZED WITH COVID-19. DURING THE EARLY PHASE OF THE PANDEMIC, THE SYSTEM ESTABLISHED TESTING SITES IN ITS COMMUNITIES TO HELP SLOW THE SPREAD OF COVID-19. THE SYSTEM WAS ONE OF THE FIRST HEALTH SYSTEMS TO OFFER COVID-19 TESTING WHEN THE PANDEMIC BEGAN AND HAS PERFORMED MORE THAN ONE MILLION TESTS IN ITS LABORATORIES IN OHIO AND FLORIDA. I. PATIENT CARE IN 2020, THE CLEVELAND CLINIC HEALTH SYSTEM INCLUDES 18 HOSPITALS; THIRTEEN OF THE HOSPITALS ARE OPERATED IN THE NORTHEAST OHIO AREA, ANCHORED BY THE CLINIC. CLEVELAND CLINIC OPERATES 21 OUTPATIENT FAMILY HEALTH CENTERS, AND 11 AMBULATORY SURGERY CENTERS, AS WELL AS NUMEROUS PHYSICIAN OFFICES, WHICH ARE LOCATED THROUGHOUT NORTHEAST OHIO. IN FLORIDA, THE CLEVELAND CLINIC HEALTH SYSTEM OPERATES FIVE HOSPITALS AND A CLINIC LOCATED THROUGHOUT SOUTHEAST FLORIDA, OUTPATIENT FAMILY HEALTH CENTERS IN WEST PALM BEACH AND PORT ST. LUCIE, AN OUTPATIENT FAMILY HEALTH AND AMBULATORY SURGERY CENTER IN CORAL SPRINGS, AND NUMEROUS PHYSICIAN OFFICES LOCATED THROUGHOUT SOUTHEAST FLORIDA. IN ADDITION, THE CLEVELAND CLINIC HEALTH SYSTEM OPERATES A HEALTH AND WELLNESS CENTER AND A SPORTS MEDICINE CLINIC IN TORONTO, CANADA, AND A SPECIALIZED NEUROLOGICAL CLINICAL CENTER IN LAS VEGAS, NEVADA. THE CLEVELAND CLINIC HEALTH SYSTEM ALSO PROVIDES CARE AT CLEVELAND CLINIC ABU DHABI; A MULTISPECIALTY HOSPITAL OFFERING CRITICAL AND ACUTE CARE SERVICES THAT IS PART OF MUBADALA DEVELOPMENT COMPANY'S NETWORK OF HEALTHCARE FACILITIES LOCATED IN ABU DHABI, UNITED ARAB EMIRATES. CLEVELAND CLINIC ABU DHABI'S CANCER TREATMENT IS MODELED AFTER THE CLINIC'S TAUSSIG CANCER CENTER AND EXPANDS THE RANGE OF CANCER TREATMENTS AVAILABLE WITH CENTRALIZED ONCOLOGY SERVICES PROVIDING DEDICATED CLINICAL PRACTICE AREAS FOR ADVANCED IMAGING, INFUSION, RADIATION, AND CHEMOTHERAPY, AS WELL AS A CONNECTION TO THE HOSPITAL'S SURGICAL AREAS. CLEVELAND CLINIC HEALTH SYSTEM IS DEDICATED TO THE COMMUNITIES IT SERVES 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 ITS FINANCIAL ASSISTANCE EFFORTS AND AS A LEADING MEDICAID PROVIDER IN OHIO, CLEVELAND CLINIC PROVIDES HEALTHCARE TO THOSE WHO OTHERWISE COULD NOT AFFORD IT. IN 2020, CLEVELAND CLINIC RECORDED 1,276 TOTAL STAFFED BEDS, 106,587 EMERGENCY VISITS, 68,590 SURGICAL CASES, 48,776 ADMISSIONS, AND MORE THAN 8.7 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 & PAIN MANAGEMENT; CANCER CENTER/TAUSSIG CANCER; CHILDREN'S & PEDIATRIC; COMMUNITY CARE; DERMATOLOGY & PLASTIC SURGERY; DIGESTIVE DISEASE & SURGERY; EMERGENCY SERVICES; ENDOCRINOLOGY & METABOLISM; COLE EYE; GENOMICS; HEAD & NECK; HEART, VASCULAR & THORACIC; IMAGING; NEUROLOGICAL; NURSING; OB/GYN & WOMEN'S HEALTH; ORTHOPAEDIC & RHEUMATOLOGIC; PATHOLOGY & LABORATORY MEDICINE; RESPIRATORY; AND UROLOGY & KIDNEY. NOTABLE ACHIEVEMENTS CLEVELAND CLINIC WAS AGAIN RECOGNIZED FOR ITS QUALITY OF CARE IN U.S. NEWS & WORLD REPORT'S PRESTIGIOUS ANNUAL AMERICA'S BEST HOSPITALS SURVEY IN 2020. OVERALL, CLEVELAND CLINIC WAS AMONG THE NATION'S BEST HOSPITALS, EARNING THE NO. 2 RANKING. FOR THE 26TH CONSECUTIVE YEAR, CLEVELAND CLINIC RANKED BEST IN THE NATION FOR CARDIOLOGY AND HEART SURGERY, EARNING THE NO. 1 SPOT. 13 CLEVELAND CLINIC SPECIALTIES ALSO RANKED IN THE TOP 10. OF THESE, NINE PLACED IN THE TOP 5 INCLUDING: CARDIOLOGY & HEART SURGERY; UROLOGY; GASTROENTEROLOGY AND GASTROINTESTINAL SURGERY; NEPHROLOGY; RHEUMATOLOGY; PULMONOLOGY AND LUNG SURGERY; CANCER; GERIATRICS AND GYNECOLOGY. CLEVELAND CLINIC WAS NATIONALLY RANKED IN 14 ADULT SPECIALTIES AND 10 CHILDREN'S SPECIALTIES. CLEVELAND CLINIC WAS ALSO RATED HIGH PERFORMING IN NINE PROCEDURES AND CONDITIONS. CLEVELAND CLINIC HAS ACHIEVED THE DISTINGUISHED MAGNET RECOGNITION. MAGNET STATUS IS THE HIGHEST NATIONAL RECOGNITION AWARDED TO A HOSPITAL OR MEDICAL CENTER FOR EXCELLENCE IN NURSING. ANCC, A SUBSIDIARY OF THE AMERICAN NURSES ASSOCIATION, GRANTS MAGNET STATUS WHEN A HEALTHCARE ORGANIZATION REFLECTS NURSING PROFESSIONALISM, TEAMWORK AND SUPERIORITY IN PATIENT CARE. FEWER THAN 400 OF THE COUNTRY'S 6,000-PLUS HOSPITALS HAVE EARNED THIS PRESTIGIOUS HONOR.

FORM 990, PART III, PROGRAM SERVICE STATEMENT (CONTINUED)

FOR THE TENTH TIME IN THE PAST 12 YEARS, CLEVELAND CLINIC HAS BEEN RECOGNIZED AS ONE OF THE WORLD'S MOST ETHICAL COMPANIES. CLEVELAND CLINIC IS ONE OF JUST FIVE HEALTHCARE PROVIDERS WORLDWIDE ON THE 2020 LIST BY THE ETHISPHERE INSTITUTE, WHICH DESCRIBES ITSELF AS "ADVANCING THE STANDARDS OF ETHICAL BUSINESS PRACTICES THAT FUEL CORPORATE CHARACTER, MARKETPLACE TRUST AND BUSINESS SUCCESS." CLEVELAND CLINIC RECEIVED SEVERAL AWARDS FROM PRACTICE GREENHEALTH. PRACTICE GREENHEALTH RECOGNIZES ORGANIZATIONS WITHIN THE HEALTHCARE SECTOR THAT SUPPORT AND CREATE BETTER, SAFER, AND GREENER WORKPLACES AND COMMUNITIES. IN 2020, CLEVELAND CLINIC AND ITS FACILITIES RECEIVED: THE ENVIRONMENTAL EXCELLENCE AWARD, GREENING THE OR AWARD, EEP (ENVIRONMENTALLY PREFERABLE PURCHASING) CIRCLE AWARD, CLIMATE CIRCLE AWARD, GREEN BUILDING CIRCLE AWARD, GREENHEALTH EMERALD AWARD, GREENHEALTH PARTNER FOR CHANGE AWARD, SYSTEM FOR CHANGE AWARD AND PARTNER RECOGNITION AWARD. FINANCIAL ASSISTANCE THE CLEVELAND CLINIC FINANCIAL ASSISTANCE POLICY ASSISTS POOR AND INDIGENT PATIENTS BY PROVIDING FREE CARE FOR EMERGENCY AND MEDICALLY NECESSARY SERVICES TO UNINSURED PATIENTS WITH INCOMES UP TO 250 PERCENT OF THE FEDERAL POVERTY LEVEL AND ALSO OFFERS DISCOUNTS ON EMERGENCY AND MEDICALLY NECESSARY SERVICES FOR UNINSURED PATIENTS WHOSE INCOME IS UP TO 400 PERCENT OF THE POVERTY LEVEL. PATIENTS WITH SPECIAL MEDICAL OR EXCEPTIONAL CIRCUMSTANCES MAY ALSO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY IS DESIGNED TO PREVENT MEDICAL BILLS FROM CAUSING A PATIENT OR FAMILY UNDUE FINANCIAL HARDSHIP. THE CLEVELAND CLINIC HEALTH SYSTEM PROVIDED FINANCIAL ASSISTANCE AT A COST OF $184.5 MILLION IN 2020. 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. 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. 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 200 FACULTY-LEVEL SCIENTISTS ORGANIZED IN THE FOLLOWING DEPARTMENTS: BIOMEDICAL ENGINEERING, CANCER BIOLOGY, CARDIOVASCULAR AND METABOLIC SCIENCES, GENOMIC MEDICINE, IMMUNOTHERAPY & PRECISION IMMUNO-ONCOLOGY, INFLAMMATION AND IMMUNITY, NEUROSCIENCES, OPHTHALMIC RESEARCH, QUANTITATIVE HEALTH SCIENCES, 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 238 RESEARCH FELLOWS, 113 GRADUATE STUDENTS AND 18 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 2020, CLEVELAND CLINIC WAS INVOLVED IN APPROXIMATELY 2,700 ACTIVE INSTITUTIONAL REVIEW BOARD APPROVED 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 2020, CLEVELAND CLINIC PROVIDED COMMUNITY BENEFIT IN RESEARCH AT A SUBSIDIZED COST OF MORE THAN $261.8 MILLION, WHICH INCLUDED EXTERNALLY- SPONSORED FUNDING OF $159.8 MILLION. 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 THE 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 2020, PROVIDED A NET COMMUNITY BENEFIT OF $309.7 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 2020, 1,045 RESIDENTS AND FELLOWS TRAINED IN 81 ACCREDITED TRAINING PROGRAMS, APPROVED BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME), INCLUDING 136 ADVANCED FELLOWS IN 80 FELLOWSHIP PROGRAMS. -LERNER COLLEGE OF MEDICINE: SINCE ITS INCEPTION IN MAY 2002, THE LERNER COLLEGE OF MEDICINE HAS LINKED ONE OF THE NATION'S TOP HOSPITALS WITH ONE OF THE NATION'S LEADING RESEARCH UNIVERSITIES. THERE WERE 1,849 APPLICANTS FOR 32 POSITIONS FOR THE 2020-21 ACADEMIC YEAR. THE PROGRAM'S STUDENTS HAVE MATCHED AT SOME OF THE MOST PRESTIGIOUS HOSPITALS THROUGHOUT THE UNITED STATES AND HAVE CONTRIBUTED 173 PUBLICATIONS TO THE WORLD'S STORE OF SCIENTIFIC KNOWLEDGE BASED ON 2020 CALENDAR YEAR (WHICH INCLUDES PUBLISHED ARTICLES AND ABSTRACT SUBMISSIONS), AND 46 STUDENTS PARTICIPATED IN LOCAL AND NATIONAL MEETINGS WITH PRESENTATIONS AND POSTERS. -VISITING MEDICAL STUDENTS: VISITING MEDICAL STUDENT EDUCATION REPRESENTS A MAJOR ACADEMIC COMMITMENT BY CLEVELAND CLINIC. IN 2020, 51 MEDICAL STUDENTS FROM 22 MEDICAL SCHOOLS AROUND THE WORLD ROTATED THROUGH CLEVELAND CLINIC. -CENTER FOR CONTINUING EDUCATION: CLEVELAND CLINIC MAINTAINS ONE OF THE LARGEST CONTINUING MEDICAL EDUCATION (CME) PROGRAMS IN THE COUNTRY AND ENJOYS THE HIGHEST ACCME RANKING: ACCREDITATION WITH COMMENDATION. IN 2020, THE CENTER FOR CONTINUING EDUCATION CERTIFIED 1,553 CME ACTIVITIES THAT OFFERED OVER 10,180 CME CREDITS TO 341,858 PARTICIPANTS. OF THAT NUMBER, 1,015 WERE LIVE COURSES THAT ATTRACTED 187,194 PARTICIPANTS. CLEVELAND CLINIC IS ONE OF THE LARGEST PROVIDERS OF ONLINE CME AMONG THE NATION'S ACADEMIC MEDICAL CENTERS. THE CENTER'S WEBSITE HAD 527 ACTIVITIES THAT ATTRACTED 198,751 ACTIVITY VIEWERS. JOURNAL CME CONTINUES TO REACH A LARGE NUMBER OF LEARNERS, AWARDING MORE THAN 63,291 CERTIFICATES TO CLEVELAND CLINIC JOURNAL OF MEDICINE (CCJM) PARTICIPANTS. IN 2020, THE CENTER ISSUED 324,793 CERTIFICATES FOR ALL ACTIVITIES COMBINED. -THE CCJM ENJOYED A CIRCULATION OF MORE THAN 128,583 COPIES AND RANKED NO. 3 IN READERSHIP AMONG JOURNALS DIRECTED TO OFFICE-BASED INTERNISTS AND CARDIOLOGISTS. EACH YEAR, THE PRINT AND ONLINE VERSIONS ARE READ OR ACCESSED BY APPROXIMATELY 7.1 MILLION PEOPLE AROUND THE WORLD. IN 2020 THE CCJM WEBSITE RECORDED 12,561,060 PAGE VIEWS FROM 9,554,530 UNIQUE VISITORS. -CENTER FOR HEALTH SCIENCES EDUCATION: CLEVELAND CLINIC IS A MAJOR EDUCATION AND TRAINING SITE FOR A NUMBER OF ALLIED HEALTH STUDENTS FROM VARIOUS ACADEMIC PROGRAMS THROUGHOUT THE REGION. THE CLEVELAND CLINIC HEALTH SYSTEM CURRENTLY OFFERS 8 IN-HOUSE ALLIED HEALTH PROGRAMS AND HAS 35 AFFILIATED PROGRAMS WITH REGIONAL ACADEMIC INSTITUTIONS. IN 2020, CLEVELAND CLINIC HEALTH SYSTEM HOSTED MORE THAN 318,848 CLINICAL ROTATION HOURS FOR OVER 892 HEALTH SCIENCE STUDENTS. -CENTER FOR INTERNATIONAL MEDICAL EDUCATION: THE CENTER FOR INTERNATIONAL MEDICAL EDUCATION (CIME) IS RESPONSIBLE FOR COORDINATING CLEVELAND CLINIC'S INTERNATIONAL EDUCATIONAL INITIATIVES AND FOR ENSURING THE PROVISION OF HIGH QUALITY EDUCATIONAL EXPERIENCES FOR THE GLOBAL MEDICAL COMMUNITY. IN 2020, 103 INTERNATIONAL PHYSICIANS AND MEDICAL STUDENTS TRAVELED TO CLEVELAND CLINIC TO PARTICIPATE IN OBSERVERSHIPS; AND STAFF TRAVELED TO 2 COUNTRIES TO SHARE CLINICAL AND SURGICAL INNOVATIONS.

FORM 990, PART III, PROGRAM SERVICE STATEMENT (CONTINUED)

IV. ADDITIONAL COMMUNITY BENEFIT PATIENT CARE PROVIDED ON A CHARITABLE BASIS, RESEARCH, AND EDUCATION DESCRIBED ABOVE ARE INTEGRAL COMPONENTS OF THE COMMUNITY BENEFIT THE CLEVELAND CLINIC HEALTH SYSTEM ANNUALLY REPORTS TO THE COMMUNITY. THE OTHER COMPONENTS OF THE CLEVELAND CLINIC'S COMMUNITY BENEFIT ARE: 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 2020, THE HEALTH SYSTEM'S UNPAID MEDICAID COSTS WERE $537.6 MILLION (THIS FIGURE IS NET OF AN HCAP BENEFIT OF $13.8 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 2020 AT A COST OF $34.4 MILLION. COMMUNITY OUTREACH PROGRAMS THE CLEVELAND CLINIC HEALTH SYSTEM IS ACTIVELY ENGAGED IN A BROAD ARRAY OF COMMUNITY OUTREACH PROGRAMS, PROVIDING OR CONTRIBUTING TO OUTREACH ACTIVITIES FOR A TOTAL NET COMMUNITY BENEFIT OF $127.4 MILLION, PARTIALLY OFFSET BY EXTERNAL FUNDING. THESE PROGRAMS ARE DESIGNED TO SERVE THE VULNERABLE AND AT-RISK POPULATIONS, AS WELL AS BROADER POPULATION IN OUR COMMUNITIES. OUR RESPONSIVE OUTREACH PROGRAMS RANGE FROM FREE WELLNESS INITIATIVES, HEALTH SCREENINGS, CLINICAL SERVICES, EDUCATION, AND YOUTH WORKFORCE DEVELOPMENT TO ENROLLMENT ASSISTANCE FOR GOVERNMENT-FUNDED HEALTH PROGRAMS. OUTREACH PROGRAMS ADDRESS DOCUMENTED HEALTH NEEDS OF OUR COMMUNITIES, ALIGN WITH OUR COMMUNITY HEALTH NEEDS ASSESSMENTS AND FALL INTO THREE MAIN CATEGORIES: COMMUNITY HEALTH SERVICES, CASH AND IN-KIND DONATIONS, AND COMMUNITY BUILDING. IN 2020, SOME HIGHLIGHTS INCLUDED: -COMMUNITY HEALTH EDUCATION AND CLINICAL SERVICES FOR COMMUNITY RESIDENTS ON COVID-19 REGARDING VIRUS IMPACT, TESTING AND VACCINE DISTRIBUTION IN LOCAL NEIGHBORHOODS. INCLUDED PARTNERSHIPS WITH HEALTH DEPARTMENTS AND COMMUNITY BASED ORGANIZATIONS. -FAITH BASED FORUMS FOR KEY COMMUNITY LEADERS ON COVID-19 EDUCATION AND ACCESS. -WELLNESS INITIATIVES TO RESIDENTS, SCHOOLS AND COMMUNITY BASED ORGANIZATIONS IN THE AREAS OF DISEASE PREVENTION, INCLUDING COVID-19 PROTOCOL, PERSONAL SAFETY, BEHAVIORAL HEALTH, STRESS MANAGEMENT, NUTRITION IMPROVEMENT AND EXERCISE. -HIGH-SPEED INTERNET ACCESS TO LOCAL COMMUNITY IN EFFORTS TO INCREASE RESIDENTS' ABILITY TO ATTEND VIRTUAL VISITS, SCHOOLS AND COMMUNITY FORUMS. -DONATIONS OF FOOD AND PERSONAL PROTECTIVE EQUIPMENT TO COMMUNITY BASED ORGANIZATIONS. -COMMUNITY FARMERS MARKETS, URBAN GARDENS AND A MOBILE FOOD PANTRY PROVIDED ACCESS TO FRESH LOCAL PRODUCTS AND SUPPLEMENTAL FOOD PROGRAMS TO ADDRESS FOOD INSECURITY ISSUES. -CLEVELAND CLINIC PROVIDED NO-COST CLINICAL CARE TO UNDER- AND UNINSURED FAMILIES AT COMMUNITY SITES, INCLUDING LANGSTON HUGHES HEALTH & EDUCATION CENTER IN FAIRFAX NEIGHBORHOOD. CARE INCLUDES MULTIGENERATIONAL WELLNESS CLASSES, CANCER SCREENING AND CHRONIC DISEASE MANAGEMENT SERVICES. -COLLABORATIVE INITIATIVES WITH COMMUNITY NONPROFIT ORGANIZATIONS AND LOCAL GOVERNMENTS ADDRESSED CRITICAL POPULATION ISSUES. TASKFORCE STRATEGIES FOCUSED ON DECREASING OPIOID PRESCRIPTIONS USE AND OVERDOSE DEATHS. HOSPITALS AND COUNTIES PROVIDED METHODS TO DECREASE INFANT MORTALITY INCLUDING PROACTIVE CENTERING PROGRAMS. -WORKFORCE DEVELOPMENT PROGRAMS TO MIDDLE SCHOOL AND HIGH SCHOOL STUDENTS TO ENHANCE GRADUATION RATES, PURSUE SECONDARY EDUCATION AND OBTAIN EMPLOYMENT. 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.

FORM 990, PART VI, SECTION A, LINE 2

DEBORAH CRAWFORD, CCF DIRECTOR & PATRICK AULETTA, CCF DIRECTOR - BUSINESS

FORM 990, PART VI, SECTION A, LINE 3

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 CLEVELAND CLINIC FOUNDATION ENTERED INTO A MANAGEMENT AGREEMENT WITH KESSLER REHABILITATION SERVICES, INC. AS PART OF A JOINT VENTURE WITH HOSPITAL HOLDINGS CORPORATION (SELECT MEDICAL") TO MANAGE AND OPERATE THREE INPATIENT REHABILITATION HOSPITAL FACILITIES. THE CLEVELAND CLINIC FOUNDATION ENTERED INTO A MANAGEMENT AGREEMENT WITH REGENCY HOSPITALS, LLC AS PART OF A JOINT VENTURE WITH SELECT UNIT MANAGEMENT, INC. (SELECT MEDICAL") TO MANAGE AND OPERATE FOUR LONG TERM ACUTE CARE FACILITIES.

FORM 990, PART VI, SECTION A, LINE 6

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 DIRECTORS. IT DOES NOT HAVE STOCKHOLDERS.

FORM 990, PART VI, SECTION A, LINE 7A

PURSUANT TO NONPROFIT CORPORATION LAW, THE "MEMBERS" OF THE CORPORATION ELECT THE BOARD OF DIRECTORS OR BOARD OF 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.

FORM 990, PART VI, SECTION A, LINE 7B

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.

FORM 990, PART VI, SECTION B, LINE 11B

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, AND MEMBERS OF THE AUDIT COMMITTEE. 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. THE FINAL E-FILED RETURN WILL BE POSTED ON THE ORGANIZATION'S WEBSITE AT WWW.CLEVELANDCLINIC.ORG.

FORM 990, PART VI, SECTION B, LINE 12C

BOARD MEMBERS AND OFFICERS OF CCF AND ITS SUBSIDIARIES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. THE DISCLOSURES ARE REVIEWED BY STAFF REPORTING TO THE CHIEF GOVERNANCE OFFICER AND ANY ITEMS THAT MAY CREATE A CONFLICT ARE BROUGHT TO HIS ATTENTION. IF THERE ANY DISCLOSURE CHANGES DURING THE YEAR OR A NEW DISCLOSURE, THE POLICY REQUIRES THAT THOSE INDIVIDUALS INFORM THE CHIEF GOVERNANCE OFFICER. THE BOARD OF DIRECTORS CONFLICT OF INTEREST AND MANAGING INNOVATIONS COMMITTEE MEETS FOUR TIMES PER YEAR AND REVIEWS THE DISCLOSURES, ANY PROPOSED ARRANGEMENTS THAT MAY INVOLVE A POTENTIAL CONFLICT OF INTEREST, AND DOCUMENTS ITS 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 THE FINAL CONSIDERATION OR VOTING ON THE ARRANGEMENTS.

FORM 990, PART VI, SECTION B, LINE 15

ALL CCF OFFICERS AND SIGNIFICANT MANAGEMENT EXECUTIVE 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, 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 SIGNIFICANT MANAGEMENT EXECUTIVE 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.

FORM 990, PART VI, SECTION C, LINE 18

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.

FORM 990, PART VI, SECTION C, LINE 19

CCF 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.

FORM 990, PART VIII, LINE 1E

THE SYSTEM HAS RECEIVED SUPPORT UNDER THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT, INCLUDING PROVIDER RELIEF FUNDS (PRF) AND THE EMPLOYEE RETENTION CREDIT (ERC). THE SYSTEM ACCOUNTED FOR BOTH THE PRF PAYMENTS AND ERC AS CONTRIBUTIONS THAT ARE RECOGNIZED AS REVENUE WHEN ANY RELATED CONDITIONS HAVE BEEN SUBSTANTIALLY MET. THE PRF PROVIDES FUNDING FROM THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) TO HEALTHCARE PROVIDERS TO SUPPORT HEALTHCARE-RELATED EXPENSES OR LOST REVENUE ATTRIBUTABLE TO COVID-19. FUNDS RECEIVED FROM THE PRF REPRESENT PAYMENTS TO PROVIDERS AND DO NOT NEED TO BE REPAID AS LONG AS THE SYSTEM COMPLIES WITH CERTAIN TERMS AND CONDITIONS IMPOSED BY HHS, INCLUDING REPORTING AND COMPLIANCE REQUIREMENTS. IN 2020, THE SYSTEM RECOGNIZED $359.2 MILLION OF PRF PAYMENTS IN OTHER UNRESTRICTED REVENUES BASED ON THE TERMS AND CONDITIONS OF THE PAYMENTS. $355 MILLION OF THE 359.2 MILLIONS IS INCLUDED ON LINE 1E. THE REMAINING $4.2 MILLION ARE ON THE SYSTEMS TAXABLE ENTITIES.

FORM 990, PART X, LINE 15

ALL SPLIT LOANS WERE REPAID OR FORGIVEN AS OF FEBRUARY 2020.

FORM 990, PART XI, LINE 9:

EQUITY TRANSFERS & OTHER TRANSFERS 610,211. GIFTS AND BEQUESTS 104,180,330. TRANSFERS OF NET ASSETS -29,809,173. NET INVESTMENT INCOME 72,478,725. NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS -45,956,097. RETIREMENT BENEFITS ADJUSTMENT -9,394,320. DONATED CAPITAL AND ASSETS RELEASED FROM RESTRICTIONS FOR CAPITAL PURPOSES 1,818,265.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

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