TY 2018 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) DONLEY MD BRIAN...................................................................... DIRECTOR, CHIEF OF STAFF (PART-YR)	50.00 .................	X	X	2,267,528	0	327,956
(2) MIHALJEVIC MD TOMISLAV...................................................................... DIRECTOR, PRESIDENT & CEO	50.00 .................	X	X	2,978,003	0	45,693
(3) MOONEY BETH E...................................................................... DIRECTOR, VICE CHAIR	5.00 .................	X	X	0	0	0
(4) RICH ROBERT E JR...................................................................... DIRECTOR, BOARD CHAIR	5.00 .................	X	X	0	0	0
(5) SCAMINACE JOSEPH M...................................................................... DIRECTOR, BOARD VICE CHAIR	5.00 .................	X	X	0	0	0
(6) WIEDEMANN MD HERBERT...................................................................... DIRECTOR, CHIEF OF STAFF	50.00 .................	X	X	985,114	0	-164,321
(7) AULETTA PATRICK V...................................................................... DIRECTOR	5.00 .................	X		0	0	0
(8) BARSOUM MD WAEL...................................................................... DIRECTOR, FLA PRES	50.00 .................	X		0	1,137,589	41,001
(9) BENZ MICHAEL...................................................................... DIRECTOR	5.00 .................	X		0	0	0
(10) CHACK DENNIS...................................................................... DIRECTOR	5.00 .................	X		0	0	0
(11) CRAWFORD DEBORAH...................................................................... DIRECTOR	5.00 .................	X		0	0	0
(12) FEDELI UMBERTO P...................................................................... DIRECTOR	5.00 .................	X		0	0	0
(13) FRANCO MD KATHLEEN...................................................................... DIRECTOR, PHYSICIAN	50.00 .................	X		280,748	0	-79,067
(14) HOOVER CAROLE...................................................................... DIRECTOR	5.00 .................	X		0	0	0
(15) KOHL STEWART...................................................................... DIRECTOR	5.00 .................	X		0	0	0
(16) KRAMER RICHARD...................................................................... DIRECTOR	5.00 .................	X		0	0	0
(17) LERNER MARK...................................................................... DIRECTOR	5.00 .................	X		0	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) LERNER NORMA........................................................................ DIRECTOR	5.00 .......................	X					0	0
(19) MACDONALD WILLIAM III........................................................................ DIRECTOR	5.00 .......................	X					0	0
(20) MILLER PAMELA........................................................................ DIRECTOR	5.00 .......................	X					0	0
(21) MILLER SAMUEL H........................................................................ DIRECTOR	5.00 .......................	X					0	0
(22) MORINO MARIO........................................................................ DIRECTOR	5.00 .......................	X					0	0
(23) NANCE FREDERICK........................................................................ DIRECTOR	5.00 .......................	X					0	0
(24) PETRAS JR MICHAEL........................................................................ DIRECTOR	5.00 .......................	X					0	0
(25) POLLOCK LARRY........................................................................ DIRECTOR	5.00 .......................	X					0	0
(26) ROSS MD RONALD J........................................................................ DIRECTOR	5.00 .......................	X					0	0
(27) SCOTT HAROLD LEE........................................................................ DIRECTOR	5.00 .......................	X					0	0
(28) SPIRO MD TIMOTHY........................................................................ DIRECTOR, PHYSICIAN	50.00 .......................	X					663,955	44,804
(29) STEVENS MARK........................................................................ DIRECTOR	5.00 .......................	X					0	0
(30) WEBER ROBERT........................................................................ DIRECTOR	5.00 .......................	X					0	0
(31) WEINBERG RONALD........................................................................ DIRECTOR	5.00 .......................	X					0	0
(32) WEISS MORRY........................................................................ DIRECTOR	5.00 .......................	X					0	0
(33) ERZURUM MD SERPIL........................................................................ CHAIR, LERNER RESEARCH INSTITUTE	50.00 .......................		X				660,650	60,017
(34) GLASS STEVEN C........................................................................ CFO & TREASURER	50.00 .......................		X				1,654,712	42,994
(35) HARRINGTON MICHAEL........................................................................ CAO & CONTROLLER	50.00 .......................		X				828,209	46,693
(36) MEEHAN MICHAEL J........................................................................ RECORDING SECRETARY	50.00 .......................		X				366,415	-50,187
(37) OBLANDER JASON........................................................................ ASST. SECRETARY	50.00 .......................		X				213,269	21,244
(38) PEACOCK WILLIAM........................................................................ CHIEF OF OPERATIONS	50.00 .......................		X				1,770,449	45,706
(39) ROWAN DAVID........................................................................ SECRETARY, CHIEF LEGAL OFFICER	50.00 .......................		X				1,631,352	46,847
(40) SABANEGH MD EDMUND........................................................................ PRESIDENT, CC MAIN CAMPUS	50.00 .......................		X				1,000,050	45,277
(41) YOUNG MD JAMES P........................................................................ CHIEF ACADEMIC OFFICER	50.00 .......................		X				900,547	45,733
(42) SURI MD RAKESH........................................................................ CEO CCAD	50.00 .......................			X			2,083,302	180,202
(43) SVENSSON MD LARS........................................................................ CHAIR OF HEART & VASCULAR INST	50.00 .......................			X			1,638,790	45,586
(44) BROOKS MD PETER........................................................................ PHYSICIAN	50.00 .......................				X		1,378,954	224,619
(45) COSGROVE MD DELOS........................................................................ FORMER CEO	50.00 .......................				X		8,718,184	-29,873
(46) HUSTON ANN........................................................................ CHIEF STRATEGY OFFICER	50.00 .......................				X		1,348,338	40,269
(47) MARTIN MD DANIEL........................................................................ COLE EYE INSTITUTE CHAIRMAN	50.00 .......................				X		1,415,256	45,553
(48) NAJM MD HANI........................................................................ PHYSICIAN	50.00 .......................				X		1,664,215	45,911
(49) HAMILTON THOMAS........................................................................ FORMER OFFICER	50.00 .......................					X	445,859	27,693
(50) MCHUGH LINDA........................................................................ FORMER OFFICER	50.00 .......................					X	885,652	44,526
(51) HAHN MD JOSEPH........................................................................ FORMER OFFICER (RETIRED)	0.00 .......................					X	148,394	0
(52) LYTLE MD BRUCE........................................................................ FORMER KEY EMPLOYEE (RETIRED)	0.00 .......................					X	118,200	0

(A) Name and business address	(B) Description of services	(C) Compensation
DONLEYSTURNER JOINT VENTURE 5430 WARNER RD CLEVELAND,OH44125	CONSTRUCTION SERVICES	32,153,670
IBM CORP 500 FIRST AVENUE PITTSBURGH,PA15219	INFORMATION TECHNOLOGY SYSTEMS SERVICES	27,441,466
SIEMENS MEDICAL SOLUTIONS INC PO BOX 121102 DALLAS,TX75312	HEALTHCARE IT & ENGINEERING SERVICES	20,547,899
WHITING-TURNER CONTRACTING CO 5875 LANDERBROOK DR STE 100 CLEVELAND,OH44124	CONSTRUCTION SERVICES	11,353,709
CARDINAL HEALTH PO BOX 70539 CHICAGO,IL60673	INTEGRATED HEALTHCARE SOLUTIONS	11,152,336
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 474

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	247,936,164	226,230,648	245,922,291	241,311,504	261,657,223	1,223,057,830
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3	247,936,164	226,230,648	245,922,291	241,311,504	261,657,223	1,223,057,830
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..						12,395,783
6	Public support. Subtract line 5 from line 4.						1,210,662,047

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
7	Amounts from line 4..	247,936,164	226,230,648	245,922,291	241,311,504	261,657,223	1,223,057,830
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	78,908,086	82,576,423	85,887,195	115,486,620	74,797,729	437,656,053
9	Net income from unrelated business activities, whether or not the business is regularly carried on..		67,175				67,175
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..	66,618,979	88,700,962	64,845,310	72,403,603	94,283,514	386,852,368
11	Total support. Add lines 7 through 10						2,047,633,426

Gross receipts from related activities, etc. (see instructions) ..................

5,615,147,430

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

59.120 %

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

55.980 %

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2018 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:	INCOMELOSS ON INVESTMENTS - 2014 AMOUNT: $ 66,455,024. 2015 AMOUNT: $ 44,378,305. 2016 AMOUNT: $ 64,640,923. 2017 AMOUNT: $ 71,980,037. 2018 AMOUNT: $ 92,689,670. FOREIGN CURRENCY - 2015 AMOUNT: $ 610,292. 2016 AMOUNT: $ 73,310. 2017 AMOUNT: $ 273,145. MISCELLANEOUS INCOME - 2014 AMOUNT: $ 17,623. GROSS INCOME FROM GAMING - 2014 AMOUNT: $ 146,332. DERIVATIVE INCOME - 2018 AMOUNT: $ 1,458,519. INVESTMENT IN AFFILIATES - 2015 AMOUNT: $ 43,529,075. LIFE INSURANCE TRUST - 2015 AMOUNT: $ 183,290. 2016 AMOUNT: $ 131,077. 2017 AMOUNT: $ 150,421. 2018 AMOUNT: $ 135,325.

Return Reference

Explanation

SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:

INCOMELOSS ON INVESTMENTS - 2014 AMOUNT: $ 66,455,024. 2015 AMOUNT: $ 44,378,305. 2016 AMOUNT: $ 64,640,923. 2017 AMOUNT: $ 71,980,037. 2018 AMOUNT: $ 92,689,670. FOREIGN CURRENCY - 2015 AMOUNT: $ 610,292. 2016 AMOUNT: $ 73,310. 2017 AMOUNT: $ 273,145. MISCELLANEOUS INCOME - 2014 AMOUNT: $ 17,623. GROSS INCOME FROM GAMING - 2014 AMOUNT: $ 146,332. DERIVATIVE INCOME - 2018 AMOUNT: $ 1,458,519. INVESTMENT IN AFFILIATES - 2015 AMOUNT: $ 43,529,075. LIFE INSURANCE TRUST - 2015 AMOUNT: $ 183,290. 2016 AMOUNT: $ 131,077. 2017 AMOUNT: $ 150,421. 2018 AMOUNT: $ 135,325.

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization THE CLEVELAND CLINIC FOUNDATION

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization THE CLEVELAND CLINIC FOUNDATION		Employer identification number 34-0714585

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization THE CLEVELAND CLINIC FOUNDATION			Employer identification number 34-0714585
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................
d	Other exempt purpose expenditures ........................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Yes

2,507

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

724,541

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

20,005

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Yes

9,486

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

756,539

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C - PART II-B, LINES 1B-1I	PART II-B 1B PAID STAFF OR MANAGEMENT - REPRESENTS ACTIVITIES DESCRIBED IN PART II-B LINES 1C-1I CONDUCTED BY MEMBERS OF THE CCF GOVERNMENT RELATIONS OFFICE PART II-B 1D MAILINGS TO MEMBERS, LEGISLATORS, OR THE PUBLIC - REPRESENTS LETTERS SENT TO LEGISLATORS AND ORGANIZATIONS ON VARIOUS HEALTHCARE RELATED TOPICS AND ISSUES PART II-B 1F GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES - REPRESENTS PAYMENT TO CERTAIN ORGANIZATIONS FOR LOBBYING SERVICES AS WELL AS PAYMENT OF DUES TO CERTAIN TRADE ORGANIZATIONS WHERE A PORTION OF THE DUES ARE USED TO CONDUCT LOBBYING ACTIVITIES PART II-B 1G DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY - REPRESENTS MEETINGS WITH AND TOURS CONDUCTED FOR LEGISLATORS AND/OR THEIR STAFF MEMBERS PART II-B 1H RALLIES, DEMONSTRATIONS, SEMINARS, CONVENTIONS, SPEECHES, LECTURES, OR ANY SIMILAR MEANS - REPRESENTS ORGANIZATION OF AND PARTICIPATION IN TRADE ASSOCIATION MEETINGS AND CONFERENCES

Return Reference

Explanation

SCHEDULE C - PART II-B, LINES 1B-1I

PART II-B 1B PAID STAFF OR MANAGEMENT - REPRESENTS ACTIVITIES DESCRIBED IN PART II-B LINES 1C-1I CONDUCTED BY MEMBERS OF THE CCF GOVERNMENT RELATIONS OFFICE PART II-B 1D MAILINGS TO MEMBERS, LEGISLATORS, OR THE PUBLIC - REPRESENTS LETTERS SENT TO LEGISLATORS AND ORGANIZATIONS ON VARIOUS HEALTHCARE RELATED TOPICS AND ISSUES PART II-B 1F GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES - REPRESENTS PAYMENT TO CERTAIN ORGANIZATIONS FOR LOBBYING SERVICES AS WELL AS PAYMENT OF DUES TO CERTAIN TRADE ORGANIZATIONS WHERE A PORTION OF THE DUES ARE USED TO CONDUCT LOBBYING ACTIVITIES PART II-B 1G DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY - REPRESENTS MEETINGS WITH AND TOURS CONDUCTED FOR LEGISLATORS AND/OR THEIR STAFF MEMBERS PART II-B 1H RALLIES, DEMONSTRATIONS, SEMINARS, CONVENTIONS, SPEECHES, LECTURES, OR ANY SIMILAR MEANS - REPRESENTS ORGANIZATION OF AND PARTICIPATION IN TRADE ASSOCIATION MEETINGS AND CONFERENCES

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.

			Held at the End of the Year
a	Total number of conservation easements ......................	2a	2
b	Total acreage restricted by conservation easements ....................	2b	50.05
c	Number of conservation easements on a certified historic structure included in (a) .....	2c	0
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d	0

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

71.00

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

$ 11,000

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2018

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	349,678,997	296,834,800	274,060,795	258,255,184	243,662,812
b	Contributions ...	15,111,719	20,870,889	14,886,901	23,968,927	8,934,335
c	Net investment earnings, gains, and losses	-5,038,774	36,978,305	14,552,559	-918,904	14,503,200
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	5,191,115	5,004,997	6,665,455	7,244,412	7,670,162
f	Administrative expenses ....
g	End of year balance ......	354,560,827	349,678,997	296,834,800	274,060,795	258,255,184

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	170,690,443		170,690,443
b	Buildings ....	3,363,486,625	1,868,943,498	1,494,543,127
c	Leasehold improvements	90,725,937	67,635,213	23,090,724
d	Equipment ....	2,151,826,766	1,523,339,565	628,487,201
e	Other .....	566,911,771	56,793,660	510,118,111
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				2,826,929,606

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) HEDGE FUNDS	1,321,633,424	F
(B) PRIVATE EQUITY	1,007,692,131	F
(C) REAL ESTATE	369,987,679	F
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	2,699,313,234

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) OTHER ASSETS				209,586,611
(2) PERPETUAL & BENEFICIAL TRUSTS				42,425,011
(3) INVESTMENT IN AFFILIATES				228,762,964
(4) DUE FROM AFFILIATES				502,452,414
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				983,227,000

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
ACCRUED PENSION	629,553,740
OTHER LIABILITIES	75,315,241
ACCRUED BENEFITS	177,329,832
FUTURE GIFT ANNUITY PAYMENTS	9,079,429
DEFERRED ANNUITY TRUST	1,033,697
INTEREST RATE SWAPS	110,862,741
DUE TO AFFILIATES	604,131,260
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,607,305,940
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART II, LINE 9:	THE CONSERVATION COVENANTS REPORTED IN PART II ARE RELATED TO TWO WETLANDS LOCATED ON THE CLEVELAND CLINIC FOUNDATION'S PROPERTY IN TWINSBURG, OHIO AND AVON, OHIO. THESE EASEMENTS ARE NOT REQUIRED TO BE REPORTED ON THE BALANCE SHEET SEPARATE FROM THE VALUE OF THE LAND. EXPENSES TO MONITOR, INSPECT, AND PROTECT THIS LAND ARE REFLECTED IN THE STATEMENT OF EXPENSES.
PART V, LINE 4:	THE ENDOWMENT FUNDS OF THE CLEVELAND CLINIC FOUNDATION ARE USED IN FURTHERANCE OF ITS EXEMPT PURPOSE. SPECIFICALLY, THESE FUNDS ARE USED FOR EDUCATION, RESEARCH, AND PATIENT CARE.
PART X, LINE 2:	THE CLEVELAND CLINIC HEALTH SYSTEM'S ("THE SYSTEM") AUDITED FINANCIAL STATEMENTS ARE REPORTED ON A CONSOLIDATED BASIS, INCLUDING EXEMPT, TAXABLE, AND FOREIGN ENTITIES TO WHICH THE ASC 740-10 LIABILITY RELATES. THE ASC 740-10 FOOTNOTE ON THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE CLEVELAND CLINIC HEALTH SYSTEM READS AS FOLLOWS: AT DECEMBER 31, 2018 AND 2017, THE LIABILITY FOR UNCERTAINTY IN INCOME TAXES WAS $0.9 MILLION AND $0.6 MILLION, RESPECTIVELY. THE SYSTEM DOES NOT EXPECT A SIGNIFICANT INCREASE OR DECREASE IN UNRECOGNIZED TAX BENEFITS WITHIN THE NEXT 12 MONTHS. THE SYSTEM RECOGNIZES INTEREST AND PENALTIES ACCRUED RELATED TO THE LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for and investments in region
	CENTRAL AMERICA & THE CARIBBEAN	0	0	PROGRAM SERVICES	INVESTMENT IN WHOLLY-OWNED FOREIGN ENTITY	2,120,000
	NORTH AMERICA	0	0	PROGRAM SERVICES	INVESTMENT IN WHOLLY-OWNED FOREIGN ENTITY	42,734,000
	EUROPE	1	13	PROGRAM SERVICES	INVESTMENT IN WHOLLY-OWNED FOREIGN ENTITY	223,016,000
	MIDDLE EAST & NORTH AFRICA	1	56	PROGRAM SERVICES	INVESTMENT IN WHOLLY-OWNED FOREIGN ENTITY	3,387,000
	CENTRAL AMERICA & THE CARIBBEAN	0	0	FUNDRAISING
	EAST ASIA & THE PACIFIC	0	0	FUNDRAISING		21,000
	EUROPE	0	0	FUNDRAISING		73,000
	MIDDLE EAST & NORTH AFRICA	0	0	FUNDRAISING		27,000
	NORTH AMERICA	0	0	FUNDRAISING
	SOUTH AMERICA	0	0	FUNDRAISING		7,000
	SOUTH ASIA	0	0	FUNDRAISING
	SUB-SAHARAN AFRICA	0	0	FUNDRAISING
	EUROPE	0	0	INVESTING		254,613,000
	NORTH AMERICA	0	0	INVESTING		60,182,000
	SUB-SAHARAN AFRICA	0	0	INVESTING		16,241,000
	CENTRAL AMERICA & THE CARIBBEAN	0	0	INVESTING		1,830,814,000

3a	Sub-total .....	2	69			271,378,000
b	Total from continuation sheets to Part I ...					2,161,857,000
c	Totals (add lines 3a and 3b)	2	69			2,433,235,000

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2018

Schedule F (Form 990) 2018

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement
NORTH AMERICA	RESEARCH	35,720	CHECK
EUROPE	RESEARCH	20,000	CHECK
EUROPE	RESEARCH	62,001	CHECK
CENTRAL AMERICA & THE CARIBBEAN	RESEARCH	19,200	CHECK
NORTH AMERICA	RESEARCH	12,500	CHECK
SOUTH AMERICA	RESEARCH	11,850	CHECK
EUROPE	RESEARCH	60,858	CHECK
EAST ASIA & THE PACIFIC	RESEARCH	54,312	CHECK
NORTH AMERICA	RESEARCH	17,005	CHECK
SOUTH AMERICA	RESEARCH	59,501	CHECK
SUB-SAHARAN AFRICA	RESEARCH	8,700	CHECK
EUROPE	RESEARCH	8,000	CHECK
SOUTH AMERICA	RESEARCH	12,394	CHECK
NORTH AMERICA	RESEARCH	354,605	CHECK
NORTH AMERICA	RESEARCH	57,982	CHECK
EUROPE	RESEARCH	100,000	CHECK

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......	12
3	Enter total number of other organizations or entities .......................	4

Schedule F (Form 990) 2018

Schedule F (Form 990) 2018Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

	(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance
RESEARCH	EAST ASIA & THE PACIFIC	1	6,045	CHECK	0
RESEARCH	EAST ASIA & THE PACIFIC	1	34,890	CHECK	0
RESEARCH	EUROPE	1	5,920	CHECK	0
RESEARCH	NORTH AMERICA	1	11,420	CHECK	0
RESEARCH	RUSSIA & NEIGHBORING STATES	1	5,332	CHECK	0
RESEARCH	EAST ASIA & THE PACIFIC	1	7,000	CHECK	0
RESEARCH	EUROPE	1	12,600	CHECK	0
RESEARCH	EUROPE	1	9,200	CHECK	0
RESEARCH	EAST ASIA & THE PACIFIC	1	5,725	CHECK	0
RESEARCH	EAST ASIA & THE PACIFIC	1	9,200	CHECK	0

Schedule F (Form 990) 2018

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2018

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
PART I, LINE 2:	A MAJORITY OF THE RESEARCH GRANTS PROVIDED TO FOREIGN ORGANIZATIONS ARE PART OF A NATIONAL INSTITUTES OF HEALTH OR FEDERALLY FUNDED PROGRAM. AS SUCH, THE FOREIGN ORGANIZATION IS REQUIRED TO MEET AND ADHERE TO FEDERAL GRANT REPORTING REQUIREMENTS WITH RESPECT TO THE USE OF THE FUNDS ON AN ON-GOING BASIS IN ORDER TO BE ELIGIBLE TO PARTICIPATE OR CONTINUE TO PARTICIPATE IN THE RESEARCH STUDY. FOR THOSE GRANTS THAT ARE NOT FEDERALLY FUNDED, A CONTRACT EXISTS WITH THE FOREIGN GRANTEE ORGANIZATION THAT ESTABLISHES HOW THE FUNDS ARE TO BE USED AND REQUIRES CERTAIN REPRESENTATIONS AND ACCOUNTING REGARDING THEIR USE. CLEVELAND CLINIC MAINTAINS OVERSIGHT OF THESE GRANTS AND REGULARLY MONITORS THEIR COMPLIANCE WITH EITHER THE FEDERAL REGULATIONS OR THE CONTRACT PROVISIONS.
PART I, LINE 3:	THE ACCRUAL METHOD IS USED TO ACCOUNT FOR EXPENDITURES.

Schedule F (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)		(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
			Yes	No
	BLACKBAUD 11501 DOMAIN DR STE 200 AUSTIN, TX78758	ONLINE GIVING		No	3,131,028	306,625	2,824,403
	RR DONNELLEY 35 WEST WACKER DRIVE CHICAGO, IL60601	DIRECT MAIL		No	1,350,375	547,804	802,571
	CLASSY 350 TENTH AVE STE 1300 SAN DIEGO, CA92101	ONLINE FUNDRAISING		No	636,552	21,628	614,924
	TSM DONOR ENGAGEMENT TEAM INC 155 COMMERCE DRIVE FREEDOM, PA15042	PHONE SOLICITATION		No	199,823	749,028	-549,205






Total . . . . . . . . . . . . . . . . . . . .					5,317,778	1,625,085	3,692,693

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2018

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 VELOSANO (event type)	(b) Event #2 CHILDREN'S GALA (event type)	(c) Other events 3 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	5,685,293	1,291,438	466,445	7,443,176
2	Less: Contributions . . . .	4,513,293	1,165,913	372,555	6,051,761
3	Gross income (line 1 minus line 2) . . . . . .	1,172,000	125,525	93,890	1,391,415

4	Cash prizes . . . . .
5	Noncash prizes . . . .			3,452	3,452
6	Rent/facility costs . . . .	204,950		12,334	217,284
7	Food and beverages . . .	122,296	171,805	83,490	377,591
8	Entertainment . . . .	59,908	16,000	2,175	78,083
9	Other direct expenses . . .	1,036,131	302,186	140,343	1,478,660
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				2,155,070
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				-763,655

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2018

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 25000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	62,979,844	0	62,979,844	1.090 %
b	Medicaid (from Worksheet 3, column a) . . . . .	683,970,459	403,553,428	280,417,031	4.850 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	0	0		0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	746,950,303	403,553,428	343,396,875	5.940 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	21,720,199	193,546	21,526,653	0.370 %
f	Health professions education (from Worksheet 5) . . .	243,317,967	25,461,535	217,856,432	3.770 %
g	Subsidized health services (from Worksheet 6) . . . .	32,007,547	23,058,689	8,948,858	0.150 %
h	Research (from Worksheet 7) .	233,620,671	158,091,487	75,529,184	1.310 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	9,402,435	444,380	8,958,055	0.150 %
j	Total. Other Benefits . .	540,068,819	207,249,637	332,819,182	5.750 %
k	Total. Add lines 7d and 7j .	1,287,019,122	610,803,065	676,216,057	11.690 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing	0
2	Economic development	15,031	15,031
3	Community support	167,715	167,715
4	Environmental improvements	0
5	Leadership development and training for community members	0
6	Coalition building	347	347
7	Community health improvement advocacy	7,900	7,900
8	Workforce development	2,269	2,269
9	Other	0
10	Total	193,262	193,262

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

160,041,131

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

695,485,401

Enter Medicare allowable costs of care relating to payments on line 5.....

734,900,720

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-39,415,319

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?8Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)								Facility reporting group
1	THE CLEVELAND CLINIC FOUNDATION 9500 EUCLID AVENUE CLEVELAND,OH44195 WWW.CLEVELANDCLINIC.ORG OH STATE ID 1151AHR	X	X	X	X	X	X
2	SELECT SPECIALTY - FAIRHILL 11900 FAIRHILL ROAD CLEVELAND,OH44120 WWW.SELECTMEDICAL.COM OH STATE ID 1468	X						A
3	SELECT SPECIALTY - REGENCY WEST 6990 ENGLE ROAD MIDDLEBURG HEIGHTS,OH44130 WWW.SELECTMEDICAL.COM OH STATE ID 1478	X						A
4	CLEVELAND CLINIC REHABILITATION - ESR 4389 MEDINA ROAD COPLEY,OH44321 WWW.CLEVELANDCLINIC.ORG OH STATE ID 1905	X						B
5	CLEVELAND CLINIC REHAB - BEACHWOOD 3025 SCIENCE PARK DRIVE BEACHWOOD,OH44012 WWW.CLEVELANDCLINIC.ORG OH STATE ID 1906	X						B
6	SELECT SPECIALTY - REGENCY EAST 4200 INTERCHANGE CORPORATE CENTER ROAD WARRENSVILLE HEIGHTS,OH44128 WWW.SELECTMEDICAL.COM OH STATE ID 1479	X						A
7	CLEVELAND CLINIC REHABILITATION-AVON 33355 HEALTH CAMPUS BOULEVARD AVON,OH44011 WWW.CLEVELANDCLINIC.ORG OH STATE ID 1522AHR	X						A
8	SELECT SPECIALTY - GATEWAY 2351 E 22ND ST 7TH FL CLEVELAND,OH44115 WWW.SELECTMEDICAL.COM OH STATE ID 1431	X						A

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	THE CLEVELAND CLINIC FOUNDATION
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.CLEVELANDCLINIC.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.CLEVELANDCLINIC.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	THE CLEVELAND CLINIC FOUNDATION
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.CLEVELANDCLINIC.ORG

The FAP application form was widely available on a website (list url):

WWW.CLEVELANDCLINIC.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.CLEVELANDCLINIC.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	THE CLEVELAND CLINIC FOUNDATION
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	THE CLEVELAND CLINIC FOUNDATION
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	REPORTING GROUP A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 17

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.CLEVELANDCLINIC.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.CLEVELANDCLINIC.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	REPORTING GROUP A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.CLEVELANDCLINIC.ORG

The FAP application form was widely available on a website (list url):

WWW.CLEVELANDCLINIC.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.CLEVELANDCLINIC.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	REPORTING GROUP A
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	REPORTING GROUP A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	REPORTING GROUP B
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Yes

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url):

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Indicate the tax year the hospital facility last adopted an implementation strategy: 20

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	REPORTING GROUP B
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.CLEVELANDCLINIC.ORG

The FAP application form was widely available on a website (list url):

WWW.CLEVELANDCLINIC.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.CLEVELANDCLINIC.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	REPORTING GROUP B
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	REPORTING GROUP B
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
THE CLEVELAND CLINIC FOUNDATION	PART V, SECTION B, LINE 5: INPUT FROM THE COMMUNITY WAS RECEIVED THROUGH KEY INFORMANT INTERVIEWS WHICH TOOK PLACE JANUARY 2016 THROUGH JULY 2016. THE KEY INFORMANTS WERE IDENTIFIED BY EACH HOSPITAL FACILITY'S LEADERSHIP AS PERSONS OR ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF EACH FACILITY'S COMMUNITY, AS DEFINED IN THE RELEVANT CHNA REPORT. THEY WERE SELECTED BASED ON THEIR INVOLVEMENT WITH THE COMMUNITY AND THEIR PARTICIPATION IN OVERALL COMMUNITY HEALTH. THE KEY INFORMANTS INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; LOCAL PUBLIC HEALTH DEPARTMENTS; AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL NEEDS OF THE COMMUNITY; REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS; AND LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. EACH KEY INFORMANT WAS INTERVIEWED OVER THE PHONE BY THE CONSULTANT, VERITE HEALTHCARE CONSULTING, LLC, USING THE SAME SET OF QUESTIONS FOR EACH PARTICIPANT. A LIST OF EACH PARTICIPANT ORGANIZATION IS IDENTIFIED IN APPENDIX G OF THE HOSPITAL FACILITY'S CHNA.
THE CLEVELAND CLINIC FOUNDATION	PART V, SECTION B, LINE 6A: CLEVELAND CLINIC FOUNDATION MAIN CAMPUS COLLABORATED WITH OTHER CLEVELAND CLINIC HEALTH SYSTEM HOSPITALS, INCLUDING: AKRON GENERAL MEDICAL CENTER, CLEVELAND CLINIC CHILDREN'S HOSPITAL, CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION, EDWIN SHAW REHABILITATION INSTITUTE, EUCLID HOSPITAL, FAIRVIEW HOSPITAL, HILLCREST HOSPITAL, LODI COMMUNITY HOSPITAL, LUTHERAN HOSPITAL, MARYMOUNT HOSPITAL, MEDINA HOSPITAL, SOUTH POINTE HOSPITAL, CLEVELAND CLINIC FLORIDA HEALTH SYSTEM. CLEVELAND CLINIC FOUNDATION MAIN CAMPUS ALSO COLLABORATED WITH ASHTABULA COUNTY MEDICAL CENTER, AND GLENBEIGH.
THE CLEVELAND CLINIC FOUNDATION	PART V, SECTION B, LINE 11: IN GENERAL THE KEY NEEDS IDENTIFIED IN ALL CCHS HOSPITAL FACILITIES WERE THE FOLLOWING: ACCESS TO AFFORDABLE HEALTHCARE; CHRONIC DISEASE AND OTHER HEALTH CONDITIONS; ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS; HEALTH PROFESSIONS EDUCATION AND RESEARCH; HEALTHCARE FOR THE ELDERLY; AND WELLNESS. HOW THE FACILITY WILL ADDRESS EACH NEED IS DESCRIBED IN DETAIL IN THE RELEVANT HOSPITAL FACILITY'S IMPLEMENTATION STRATEGY REPORT.CLEVELAND CLINIC CANNOT DIRECTLY ADDRESS THOSE COMMUNITY NEEDS THAT DO NOT RELATE DIRECTLY TO THE HOSPITAL'S MISSION TO DELIVER HEALTH CARE. THESE ARE NEEDS THAT OTHER GOVERNMENTAL AND/OR NONPROFIT ORGANIZATIONS HAVE MORE APPROPRIATE EXPERTISE AND RESOURCES TO ADDRESS. ALTHOUGH CLEVELAND CLINIC CANNOT ADDRESS THESE NEEDS DIRECTLY, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS.CLEVELAND CLINIC CANNOT ADDRESS THE FOLLOWING COMMUNITY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT: ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS (INCLUDING BETTER EMPLOYMENT OPPORTUNITIES, LOWER CRIME RATES, ADEQUATE SOCIAL SERVICES, AND OTHER ENVIRONMENTAL CONDITIONS).CLEVELAND CLINIC CANNOT FOCUS ON OR OTHERWISE ADDRESS THE NEED FOR COMMUNITY SERVICES UNRELATED TO THE DELIVERY OF HEALTHCARE. ALTHOUGH CLEVELAND CLINIC IS NOT DIRECTLY INVOLVED WITH DEVELOPING COMMUNITY INFRASTRUCTURE AND IMPROVING THE ECONOMY BECAUSE ITS MISSION RELATES TO DELIVERY OF QUALITY HEALTHCARE, IT DOES AND WILL CONTINUE TO SUPPORT LOCAL CHAMBERS OF COMMERCE AND COMMUNITY DEVELOPMENT ORGANIZATIONS, COLLABORATE WITH LEADERS OF REGIONAL ECONOMIC IMPROVEMENT AND PROVIDE IN-KIND DONATION OF TIME, SKILL AND/OR SPONSORSHIPS TO SUPPORT EFFORTS IN THESE AREAS.
THE CLEVELAND CLINIC FOUNDATION	PART V, SECTION B, LINE 13B: PATIENTS WHO DO NOT MEET FINANCIAL CRITERIA FOR ASSISTANCE BASED ON FEDERAL POVERTY LEVEL MAY NONETHELESS QUALIFY FOR ASSISTANCE IF THEIR MEDICAL EXPENSES EXCEED 15% OF THEIR ANNUAL FAMILY INCOME.
THE CLEVELAND CLINIC FOUNDATION	PART V, SECTION B, LINE 15E: IN ADDITION TO APPLYING BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION, PATIENTS MAY BE EVALUATED UPON SCHEDULING OR PRIOR TO ADMISSION BY CCHS. UNINSURED PATIENTS THAT CCHS DETERMINES THROUGH THIRD PARTY VERIFICATION SOURCES TO HAVE ANNUAL FAMILY INCOME UNDER 400% OF THE FEDERAL POVERTY GUIDELINES WILL BE DEEMED ELIGIBLE AND NOTIFIED AS SUCH IN WRITING. IF THE PATIENT BELIEVES THEY QUALIFY FOR ADDITIONAL ASSISTANCE, THEY MAY SUBMIT A COMPLETED APPLICATION FOR CONSIDERATION.
THE CLEVELAND CLINIC FOUNDATION	PART V, SECTION B, LINE 16J: INFORMING THE PUBLIC THAT FINANCIAL ASSISTANCE IS AVAILABLE IS AN IMPORTANT ELEMENT OF OUR FINANCIAL ASSISTANCE PROGRAM AND THE CLEVELAND CLINIC CONTINUOUSLY STRIVES TO IMPROVE ITS COMMUNICATIONS WITH PATIENTS ON THE AVAILABILITY OF FINANCIAL ASSISTANCE. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE CLEVELAND CLINIC WEBSITE. PATIENT BILLS INCLUDE DETAILED INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE THROUGHOUT CCF, INCLUDING IN PATIENT REGISTRATION AREAS, ONLINE, AND WITH FINANCIAL COUNSELORS WHO ARE PRESENT ON-SITE AT EACH CLEVELAND CLINIC HOSPITAL AND OHIO FAMILY HEALTH CENTER TO ASSIST PATIENTS IN QUALIFYING FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND FINANCIAL ASSISTANCE. A DESCRIPTION OF THE POLICY IS ALSO INCLUDED IN OUR INSURANCE AND BILLING INFORMATION PATIENT BROCHURE, WHICH IS AVAILABLE AT REGISTRATION DESKS WITH FINANCIAL COUNSELORS.
THE CLEVELAND CLINIC FOUNDATION	PART V, SECTION B, LINE 20E: IN ADDITION TO ITEMS LISTED IN 20A-D, CCHS NOTIFIES INDIVIDUALS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IN COMMUNICATIONS WITH PATIENTS ABOUT APPOINTMENT REMINDERS, IN THEIR DISCHARGE SUMMARY, IN THE ON HOLD MESSAGE IF THEY CALL CUSTOMER SERVICE, AND ON WEB PAGES INCLUDING THE ONLINE BILL PAY PORTAL.
PART V, SECTION B	FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF:	- FACILITY 3: SELECT SPECIALTY - REGENCY WEST, - FACILITY 6: SELECT SPECIALTY - REGENCY EAST, - FACILITY 2: SELECT SPECIALTY - FAIRHILL, - FACILITY 8: SELECT SPECIALTY - GATEWAY, - FACILITY 7: CLEVELAND CLINIC REHABILITATION-AVON
GROUP A-FACILITY 3 -- SELECT SPECIALTY - REGENCY WEST PART V, SECTION B, LINE 5:	INPUT FROM THE COMMUNITY WAS RECEIVED THROUGH KEY INFORMANT INTERVIEWS CONDUCTED BETWEEN JUNE AND OCTOBER 2017.25 KEY INFORMANTS WERE IDENTIFIED BY THE HOSPITAL FACILITY'S LEADERSHIP AS PERSONS OR ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF EACH FACILITY'S COMMUNITY, AS DEFINED IN THE RELEVANT CHNA REPORT. THEY WERE SELECTED BASED ON THEIR INVOLVEMENT WITH THE COMMUNITY AND THEIR PARTICIPATION IN OVERALL COMMUNITY HEALTH. THE KEY INFORMANTS INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; LOCAL PUBLIC HEALTH DEPARTMENTS; AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL NEEDS OF THE COMMUNITY; REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS; AND LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. A LIST OF EACH PARTICIPANT ORGANIZATION IS IDENTIFIED IN APPENDIX C OF THE HOSPITAL FACILITY'S CHNA.
GROUP A-FACILITY 3 -- SELECT SPECIALTY - REGENCY WEST PART V, SECTION B, LINE 6A:	SELECT SPECIALTY - REGENCY WEST COLLABORATED WITH THE CLEVELAND CLINIC HEALTH SYSTEM AND THE FOLLOWING SELECT MEDICAL HOSPITALS: SELECT SPECIALTY HOSPITAL - CLEVELAND FAIRHILL, SELECT SPECIALTY HOSPITAL - CLEVELAND GATEWAY, REGENCY HOSPITAL OF CLEVELAND EAST, AND CLEVELAND CLINIC REHABILITATION - AVON.
GROUP A-FACILITY 3 -- SELECT SPECIALTY - REGENCY WEST PART V, SECTION B, LINE 11:	IN GENERAL THE KEY NEEDS IDENTIFIED IN ALL CLEVELAND CLINIC/SELECT HOSPITAL FACILITIES WERE THE FOLLOWING: ACCESS TO AFFORDABLE HEALTHCARE; CHRONIC DISEASE AND OTHER HEALTH CONDITIONS; ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS; HEALTHCARE FOR THE ELDERLY; AND WELLNESS. HOW THE FACILITY WILL ADDRESS EACH NEED IS DESCRIBED IN DETAIL IN THE RELEVANT HOSPITAL FACILITY'S IMPLEMENTATION STRATEGY REPORT.SELECT SPECIALTY - REGENCY WEST CANNOT DIRECTLY ADDRESS THOSE COMMUNITY NEEDS THAT DO NOT RELATE DIRECTLY TO THE HOSPITAL'S MISSION TO DELIVER HEALTH CARE. THESE ARE NEEDS THAT OTHER GOVERNMENTAL AND/OR NONPROFIT ORGANIZATIONS HAVE MORE APPROPRIATE EXPERTISE AND RESOURCES TO ADDRESS. ALTHOUGH SELECT SPECIALTY - REGENCY WEST CANNOT ADDRESS THESE NEEDS DIRECTLY, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS.SELECT SPECIALTY - REGENCY WEST CANNOT ADDRESS THE FOLLOWING COMMUNITY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT: ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS (INCLUDING HIGH RATES OF POVERTY, HOUSING ISSUES, CRIME, AIR POLLUTION, INADEQUATE TRANSPORTATION AND UNDERSUPPLY OF NEEDED SOCIAL SERVICES).SELECT SPECIALTY - REGENCY WEST CANNOT FOCUS ON OR OTHERWISE ADDRESS THE NEED FOR COMMUNITY SERVICES UNRELATED TO THE DELIVERY OF HEALTHCARE. ALTHOUGH SELECT SPECIALTY - REGENCY WEST IS NOT DIRECTLY INVOLVED WITH ECONOMIC DEVELOPMENT OR COMMUNITY CONDITIONS, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS. SELECT SPECIALTY - REGENCY WEST SERVICES POPULATIONS ACROSS NORTHEAST OHIO AND THUS HAS A WIDE-REACHING ECONOMIC IMPACT THROUGH ITS HIRING PRACTICES TO SUPPORT PATIENT CARE.
GROUP A-FACILITY 3 -- SELECT SPECIALTY - REGENCY WEST PART V, SECTION B, LINE 20D:	PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE THROUGHOUT ANY POINT IN THE CARE PROCESS.
GROUP A-FACILITY 6 -- SELECT SPECIALTY - REGENCY EAST PART V, SECTION B, LINE 5:	INPUT FROM THE COMMUNITY WAS RECEIVED THROUGH KEY INFORMANT INTERVIEWS CONDUCTED BETWEEN JUNE AND OCTOBER 2017.25 KEY INFORMANTS WERE IDENTIFIED BY THE HOSPITAL FACILITY'S LEADERSHIP AS PERSONS OR ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF EACH FACILITY'S COMMUNITY, AS DEFINED IN THE RELEVANT CHNA REPORT. THEY WERE SELECTED BASED ON THEIR INVOLVEMENT WITH THE COMMUNITY AND THEIR PARTICIPATION IN OVERALL COMMUNITY HEALTH. THE KEY INFORMANTS INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; LOCAL PUBLIC HEALTH DEPARTMENTS; AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL NEEDS OF THE COMMUNITY; REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS; AND LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. A LIST OF EACH PARTICIPANT ORGANIZATION IS IDENTIFIED IN APPENDIX C OF THE HOSPITAL FACILITY'S CHNA.
GROUP A-FACILITY 6 -- SELECT SPECIALTY - REGENCY EAST PART V, SECTION B, LINE 6A:	SELECT SPECIALTY - REGENCY EAST COLLABORATED WITH THE CLEVELAND CLINIC HEALTH SYSTEM AND FOLLOWING SELECT MEDICAL HOSPITALS: SELECT SPECIALTY HOSPITAL - CLEVELAND FAIRHILL, SELECT SPECIALTY HOSPITAL - CLEVELAND GATEWAY, REGENCY HOSPITAL OF CLEVELAND WEST, AND CLEVELAND CLINIC REHABILITATION - AVON.
GROUP A-FACILITY 6 -- SELECT SPECIALTY - REGENCY EAST PART V, SECTION B, LINE 11:	IN GENERAL THE KEY NEEDS IDENTIFIED IN ALL CLEVELAND CLINIC/SELECT HOSPITAL FACILITIES WERE THE FOLLOWING: ACCESS TO AFFORDABLE HEALTHCARE; CHRONIC DISEASE AND OTHER HEALTH CONDITIONS; ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS; HEALTHCARE FOR THE ELDERLY; AND WELLNESS. HOW THE FACILITY WILL ADDRESS EACH NEED IS DESCRIBED IN DETAIL IN THE RELEVANT HOSPITAL FACILITY'S IMPLEMENTATION STRATEGY REPORT.SELECT SPECIALTY - REGENCY EAST CANNOT DIRECTLY ADDRESS THOSE COMMUNITY NEEDS THAT DO NOT RELATE DIRECTLY TO THE HOSPITAL'S MISSION TO DELIVER HEALTH CARE. THESE ARE NEEDS THAT OTHER GOVERNMENTAL AND/OR NONPROFIT ORGANIZATIONS HAVE MORE APPROPRIATE EXPERTISE AND RESOURCES TO ADDRESS. ALTHOUGH SELECT SPECIALTY - REGENCY EAST CANNOT ADDRESS THESE NEEDS DIRECTLY, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS.SELECT SPECIALTY - REGENCY EAST CANNOT ADDRESS THE FOLLOWING COMMUNITY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT: ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS (INCLUDING HIGH RATES OF POVERTY, HOUSING ISSUES, CRIME, AIR POLLUTION, INADEQUATE TRANSPORTATION AND UNDERSUPPLY OF NEEDED SOCIAL SERVICES).SELECT SPECIALTY - REGENCY EAST CANNOT FOCUS ON OR OTHERWISE ADDRESS THE NEED FOR COMMUNITY SERVICES UNRELATED TO THE DELIVERY OF HEALTHCARE. ALTHOUGH SELECT SPECIALTY - REGENCY EAST IS NOT DIRECTLY INVOLVED WITH ECONOMIC DEVELOPMENT OR COMMUNITY CONDITIONS, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS. SELECT SPECIALTY - REGENCY EAST SERVICES POPULATIONS ACROSS NORTHEAST OHIO AND THUS HAS A WIDE-REACHING ECONOMIC IMPACT THROUGH ITS HIRING PRACTICES TO SUPPORT PATIENT CARE.
GROUP A-FACILITY 6 -- SELECT SPECIALTY - REGENCY EAST PART V, SECTION B, LINE 20D:	PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE THROUGHOUT ANY POINT IN THE CARE PROCESS.
GROUP A-FACILITY 2 -- SELECT SPECIALTY - FAIRHILL PART V, SECTION B, LINE 5:	INPUT FROM THE COMMUNITY WAS RECEIVED THROUGH KEY INFORMANT INTERVIEWS CONDUCTED BETWEEN JUNE AND OCTOBER 2017.25 KEY INFORMANTS WERE IDENTIFIED BY THE HOSPITAL FACILITY'S LEADERSHIP AS PERSONS OR ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF EACH FACILITY'S COMMUNITY, AS DEFINED IN THE RELEVANT CHNA REPORT. THEY WERE SELECTED BASED ON THEIR INVOLVEMENT WITH THE COMMUNITY AND THEIR PARTICIPATION IN OVERALL COMMUNITY HEALTH. THE KEY INFORMANTS INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; LOCAL PUBLIC HEALTH DEPARTMENTS; AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL NEEDS OF THE COMMUNITY; REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS; AND LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. A LIST OF EACH PARTICIPANT ORGANIZATION IS IDENTIFIED IN APPENDIX C OF THE HOSPITAL FACILITY'S CHNA.
GROUP A-FACILITY 2 -- SELECT SPECIALTY - FAIRHILL PART V, SECTION B, LINE 6A:	SELECT SPECIALTY - FAIRHILL COLLABORATED WITH THE CLEVELAND CLINIC HEALTH SYSTEM AND THE FOLLOWING SELECT MEDICAL HOSPITALS: SELECT SPECIALTY HOSPITAL - CLEVELAND GATEWAY, REGENCY HOSPITAL OF CLEVELAND WEST, REGENCY HOSPITAL OF CLEVELAND EAST, AND CLEVELAND CLINIC REHABILITATION - AVON.
GROUP A-FACILITY 2 -- SELECT SPECIALTY - FAIRHILL PART V, SECTION B, LINE 11:	IN GENERAL THE KEY NEEDS IDENTIFIED IN ALL CLEVELAND CLINIC/SELECT HOSPITAL FACILITIES WERE THE FOLLOWING: ACCESS TO AFFORDABLE HEALTHCARE; CHRONIC DISEASE AND OTHER HEALTH CONDITIONS; ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS; HEALTHCARE FOR THE ELDERLY; AND WELLNESS. HOW THE FACILITY WILL ADDRESS EACH NEED IS DESCRIBED IN DETAIL IN THE RELEVANT HOSPITAL FACILITY'S IMPLEMENTATION STRATEGY REPORT.SELECT SPECIALTY - FAIRHILL CANNOT DIRECTLY ADDRESS THOSE COMMUNITY NEEDS THAT DO NOT RELATE DIRECTLY TO THE HOSPITAL'S MISSION TO DELIVER HEALTH CARE. THESE ARE NEEDS THAT OTHER GOVERNMENTAL AND/OR NONPROFIT ORGANIZATIONS HAVE MORE APPROPRIATE EXPERTISE AND RESOURCES TO ADDRESS. ALTHOUGH SELECT SPECIALTY - FAIRHILL CANNOT ADDRESS THESE NEEDS DIRECTLY, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS.SELECT SPECIALTY - FAIRHILL CANNOT ADDRESS THE FOLLOWING COMMUNITY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT: ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS (INCLUDING HIGH RATES OF POVERTY, HOUSING ISSUES, CRIME, AIR POLLUTION, INADEQUATE TRANSPORTATION AND UNDERSUPPLY OF NEEDED SOCIAL SERVICES).SELECT SPECIALTY - FAIRHILL CANNOT FOCUS ON OR OTHERWISE ADDRESS THE NEED FOR COMMUNITY SERVICES UNRELATED TO THE DELIVERY OF HEALTHCARE. ALTHOUGH SELECT SPECIALTY - FAIRHILL IS NOT DIRECTLY INVOLVED WITH ECONOMIC DEVELOPMENT OR COMMUNITY CONDITIONS, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS. SELECT SPECIALTY - FAIRHILL SERVICES POPULATIONS ACROSS NORTHEAST OHIO AND THUS HAS A WIDE-REACHING ECONOMIC IMPACT THROUGH ITS HIRING PRACTICES TO SUPPORT PATIENT CARE.
GROUP A-FACILITY 2 -- SELECT SPECIALTY - FAIRHILL PART V, SECTION B, LINE 20D:	PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE THROUGHOUT ANY POINT IN THE CARE PROCESS.
GROUP A-FACILITY 8 -- SELECT SPECIALTY - GATEWAY PART V, SECTION B, LINE 5:	INPUT FROM THE COMMUNITY WAS RECEIVED THROUGH KEY INFORMANT INTERVIEWS CONDUCTED BETWEEN JUNE AND OCTOBER 2017.25 KEY INFORMANTS WERE IDENTIFIED BY THE HOSPITAL FACILITY'S LEADERSHIP AS PERSONS OR ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF EACH FACILITY'S COMMUNITY, AS DEFINED IN THE RELEVANT CHNA REPORT. THEY WERE SELECTED BASED ON THEIR INVOLVEMENT WITH THE COMMUNITY AND THEIR PARTICIPATION IN OVERALL COMMUNITY HEALTH. THE KEY INFORMANTS INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; LOCAL PUBLIC HEALTH DEPARTMENTS; AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL NEEDS OF THE COMMUNITY; REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS; AND LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. A LIST OF EACH PARTICIPANT ORGANIZATION IS IDENTIFIED IN APPENDIX C OF THE HOSPITAL FACILITY'S CHNA.
GROUP A-FACILITY 8 -- SELECT SPECIALTY - GATEWAY PART V, SECTION B, LINE 6A:	SELECT SPECIALTY - GATEWAY COLLABORATED WITH THE CLEVELAND CLINIC HEALTH SYSTEM AND THE FOLLOWING SELECT MEDICAL HOSPITALS: SELECT SPECIALTY HOSPITAL - CLEVELAND FAIRHILL, REGENCY HOSPITAL OF CLEVELAND WEST, REGENCY HOSPITAL OF CLEVELAND EAST, AND CLEVELAND CLINIC REHABILITATION - AVON.
GROUP A-FACILITY 8 -- SELECT SPECIALTY - GATEWAY PART V, SECTION B, LINE 11:	IN GENERAL THE KEY NEEDS IDENTIFIED IN ALL CLEVELAND CLINIC/SELECT HOSPITAL FACILITIES WERE THE FOLLOWING: ACCESS TO AFFORDABLE HEALTHCARE; CHRONIC DISEASE AND OTHER HEALTH CONDITIONS; ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS; HEALTHCARE FOR THE ELDERLY; AND WELLNESS. HOW THE FACILITY WILL ADDRESS EACH NEED IS DESCRIBED IN DETAIL IN THE RELEVANT HOSPITAL FACILITY'S IMPLEMENTATION STRATEGY REPORT.SELECT SPECIALTY - GATEWAY CANNOT DIRECTLY ADDRESS THOSE COMMUNITY NEEDS THAT DO NOT RELATE DIRECTLY TO THE HOSPITAL'S MISSION TO DELIVER HEALTH CARE. THESE ARE NEEDS THAT OTHER GOVERNMENTAL AND/OR NONPROFIT ORGANIZATIONS HAVE MORE APPROPRIATE EXPERTISE AND RESOURCES TO ADDRESS. ALTHOUGH SELECT SPECIALTY - GATEWAY CANNOT ADDRESS THESE NEEDS DIRECTLY, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS.SELECT SPECIALTY - GATEWAY CANNOT ADDRESS THE FOLLOWING COMMUNITY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT: ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS (INCLUDING HIGH RATES OF POVERTY, HOUSING ISSUES, CRIME, AIR POLLUTION, INADEQUATE TRANSPORTATION AND UNDERSUPPLY OF NEEDED SOCIAL SERVICES).SELECT SPECIALTY - GATEWAY CANNOT FOCUS ON OR OTHERWISE ADDRESS THE NEED FOR COMMUNITY SERVICES UNRELATED TO THE DELIVERY OF HEALTHCARE. ALTHOUGH SELECT SPECIALTY - GATEWAY IS NOT DIRECTLY INVOLVED WITH ECONOMIC DEVELOPMENT OR COMMUNITY CONDITIONS, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS. SELECT SPECIALTY - GATEWAY SERVICES POPULATIONSACROSS NORTHEAST OHIO AND THUS HAS A WIDE-REACHING ECONOMIC IMPACT THROUGH ITS HIRING PRACTICES TO SUPPORT PATIENT CARE.
GROUP A-FACILITY 8 -- SELECT SPECIALTY - GATEWAY PART V, SECTION B, LINE 20D:	PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE THROUGHOUT ANY POINT IN THE CARE PROCESS.
GROUP A-FACILITY 7 -- CLEVELAND CLINIC REHABILITATION- AVON PART V, SECTION B, LINE 5:	INPUT FROM THE COMMUNITY WAS RECEIVED THROUGH KEY INFORMANT INTERVIEWS CONDUCTED BETWEEN JUNE AND OCTOBER 2017.25 KEY INFORMANTS WERE IDENTIFIED BY THE HOSPITAL FACILITY'S LEADERSHIP AS PERSONS OR ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF EACH FACILITY'S COMMUNITY, AS DEFINED IN THE RELEVANT CHNA REPORT. THEY WERE SELECTED BASED ON THEIR INVOLVEMENT WITH THE COMMUNITY AND THEIR PARTICIPATION IN OVERALL COMMUNITY HEALTH. THE KEY INFORMANTS INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; LOCAL PUBLIC HEALTH DEPARTMENTS; AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH NEEDS AND SOCIAL NEEDS OF THE COMMUNITY; REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS; AND LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. A LIST OF EACH PARTICIPANT ORGANIZATION IS IDENTIFIED IN APPENDIX C OF THE HOSPITAL FACILITY'S CHNA.
GROUP A-FACILITY 7 -- CLEVELAND CLINIC REHABILITATION- AVON PART V, SECTION B, LINE 6A:	CLEVELAND CLINIC REHABILITATION - AVON COLLABORATED WITH THE CLEVELAND CLINIC HEALTH SYSTEM AND THE FOLLOWING SELECT MEDICAL HOSPITALS: SELECT SPECIALTY HOSPITAL - CLEVELAND FAIRHILL, SELECT SPECIALTY HOSPITAL - CLEVELAND GATEWAY, REGENCY HOSPITAL OF CLEVELAND EAST, AND REGENCY HOSPITAL OF CLEVELAND WEST.
GROUP A-FACILITY 7 -- CLEVELAND CLINIC REHABILITATION- AVON PART V, SECTION B, LINE 11:	IN GENERAL THE KEY NEEDS IDENTIFIED IN ALL CLEVELAND CLINIC/SELECT HOSPITAL FACILITIES WERE THE FOLLOWING: ACCESS TO AFFORDABLE HEALTHCARE; CHRONIC DISEASE AND OTHER HEALTH CONDITIONS; ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS; HEALTHCARE FOR THE ELDERLY; AND WELLNESS. HOW THE FACILITY WILL ADDRESS EACH NEED IS DESCRIBED IN DETAIL IN THE RELEVANT HOSPITAL FACILITY'S IMPLEMENTATION STRATEGY REPORT.CLEVELAND CLINIC REHABILITATION - AVON CANNOT DIRECTLY ADDRESS THOSE COMMUNITY NEEDS THAT DO NOT RELATE DIRECTLY TO THE HOSPITAL'S MISSION TO DELIVER HEALTH CARE. THESE ARE NEEDS THAT OTHER GOVERNMENTAL AND/OR NONPROFIT ORGANIZATIONS HAVE MORE APPROPRIATE EXPERTISE AND RESOURCES TO ADDRESS. ALTHOUGH CLEVELAND CLINIC REHABILITATION - AVON CANNOT ADDRESS THESE NEEDS DIRECTLY, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS.CLEVELAND CLINIC REHABILITATION - AVON CANNOT ADDRESS THE FOLLOWING COMMUNITY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT: ECONOMIC DEVELOPMENT AND COMMUNITY CONDITIONS (INCLUDING HIGH RATES OF POVERTY, HOUSING ISSUES, CRIME, AIR POLLUTION, INADEQUATE TRANSPORTATION AND UNDERSUPPLY OF NEEDED SOCIAL SERVICES).CLEVELAND CLINIC REHABILITATION - AVON CANNOT FOCUS ON OR OTHERWISE ADDRESS THE NEED FOR COMMUNITY SERVICES UNRELATED TO THE DELIVERY OF HEALTHCARE. ALTHOUGH CLEVELAND CLINIC REHABILITATION -AVON IS NOT DIRECTLY INVOLVED WITH ECONOMIC DEVELOPMENT OR COMMUNITY CONDITIONS, IT DOES SUPPORT GOVERNMENTAL AND OTHER AGENCIES IN THEIR EFFORTS TO HELP WITH THESE NEEDS. CLEVELAND CLINIC REHABILITATION - AVON SERVICES POPULATIONS ACROSS NORTHEAST OHIO AND THUS HAS A WIDE-REACHING ECONOMIC IMPACT THROUGH ITS HIRING PRACTICES TO SUPPORT PATIENT CARE.
GROUP A-FACILITY 7 -- CLEVELAND CLINIC REHABILITATION- AVON PART V, SECTION B, LINE 16J:
GROUP A-FACILITY 7 -- CLEVELAND CLINIC REHABILITATION- AVON PART V, SECTION B, LINE 20D:	PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE THROUGHOUT ANY POINT IN THE CARE PROCESS.
PART V, SECTION B	FACILITY REPORTING GROUP B
FACILITY REPORTING GROUP B CONSISTS OF:	- FACILITY 5: CLEVELAND CLINIC REHAB - BEACHWOOD, - FACILITY 4: CLEVELAND CLINIC REHABILITATION - ESR
GROUP B-FACILITY 4 -- CLEVELAND CLINIC REHAB - ESR PART V, SECTION B, LINE 2:	CLEVELAND CLINIC REHABILITATION - EDWIN SHAW OPENED IN NOVEMBER 2017.
GROUP B-FACILITY 4 -- CLEVELAND CLINIC REHAB - ESR PART V, SECTION B, LINE 20D:	PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE THROUGHOUT ANY POINT IN THE CARE PROCESS.
GROUP B-FACILITY 5 -- CLEVELAND CLINIC REHAB - BEACHWOOD PART V, SECTION B, LINE 2:	CLEVELAND CLINIC REHABILITATION - BEACHWOOD OPENED IN OCTOBER 2017.
GROUP B-FACILITY 5 -- CLEVELAND CLINIC REHAB - BEACHWOOD PART V, SECTION B, LINE 20D:	PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE THROUGHOUT ANY POINT IN THE CARE PROCESS.

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?118
Name and address		Type of Facility (describe)
1	1 - TWINSBURG FAMILY HEALTH & SURGERY CENTER 8701 DARROW RD TWINSBURG,OH44087	FAMILY HEALTH CENTER
2	2 - BEACHWOOD FAMILY HEALTH & SURGERY CENTER 26900 CEDAR RD BEACHWOOD,OH44122	FAMILY HEALTH CENTER
3	3 - STRONGSVILLE FAMILY HEALTH & SURGERY CEN 16761 SOUTH PARK CENTER STRONGSVILLE,OH44136	FAMILY HEALTH CENTER
4	4 - RICHARD E JACOBS HEALTH CENTER 33100 CLEVELAND CLINIC BLVD AVON,OH44011	FAMILY HEALTH CENTER
5	5 - INDEPENDENCE FAMILY HEALTH CENTER 5001 ROCKSIDE RD CROWN CENTRE II INDEPENDENCE,OH44131	FAMILY HEALTH CENTER
6	6 - LORAIN FAMILY HEALTH & SURGERY CENTER 5700 COOPER FOSTER PARK RD LORAIN,OH44053	FAMILY HEALTH CENTER
7	7 - WILLOUGHBY HILLS FAMILY HEALTH CENTER 2550 2570 SOM CENTER RD WILLOUGHBY HILLS,OH44094	FAMILY HEALTH CENTER
8	8 - WOOSTER FAMILY HEALTH CENTER 1740 CLEVELAND RD WOOSTER,OH44691	FAMILY HEALTH CENTER
9	9 - BRUNSWICK FAMILY HEALTH CENTER 3574 CENTER RD BRUNSWICK,OH44212	FAMILY HEALTH CENTER
10	10 - CLEVELAND CLINIC CANCER CENTERS 417 QUARRY LAKES DR SANDUSKY,OH44870	OUTPATIENT PHYSICIAN CLINIC
11	11 - SOLON FAMILY HEALTH CENTER 29800 BAINBRIDGE RD SOLON,OH44139	FAMILY HEALTH CENTER
12	12 - CLEVELAND CLINIC CANCER CENTERS 1125 ASPIRA CT MANSFIELD,OH44906	OUTPATIENT PHYSICIAN CLINIC
13	13 - ELYRIA FAMILY HEALTH & SURGERY CENTER 303 CHESTNUT COMMONS DR ELYRIA,OH44035	FAMILY HEALTH CENTER
14	14 - SUPERIOR MEDICAL SHEFFIELD FAMILY HEALTH 5334 MEADOW LANE CT SHEFFIELD VILLAGE,OH44035	OUTPATIENT PHYSICIAN CLINIC
15	15 - LAKEWOOD FAMILY HEALTH CENTER 16215 MADISON AVE LAKEWOOD,OH44107	FAMILY HEALTH CENTER
16	16 - LANDERBROOK OFFICE AND ENDOSCOPY CENTER 5900 LANDERBROOK DR MAYFIELD HEIGHTS,OH44124	OUTPATIENT PHYSICIAN CLINIC
17	17 - CHAGRIN FALLS FAMILY HEALTH CENTER 551 EAST WASHINGTON ST CHAGRIN FALLS,OH44022	FAMILY HEALTH CENTER
18	18 - AVON POINTE FAMILY HEALTH CENTER 36901 AMERICAN WAY AVON,OH44011	FAMILY HEALTH CENTER
19	19 - NORTH OHIO GASTROENTEROLOGY 30701 CLEMENS RD WESTLAKE,OH44145	OUTPATIENT PHYSICIAN CLINIC
20	20 - AMHERST FAMILY HEALTH CENTER 5172 LEAVITT RD LORAIN,OH44053	FAMILY HEALTH CENTER
21	21 - STEPHANIE TUBBS JONES HEALTH CENTER 13944 EUCLID AVE EAST CLEVELAND,OH44112	FAMILY HEALTH CENTER
22	22 - AVON LAKE FAMILY HEALTH CENTER 450 AVON BELDEN RD AVON LAKE,OH44012	FAMILY HEALTH CENTER
23	23 - SUMMIT GASTROENTEROLOGY ASSOCIATES 3939 S CLEVELAND MASSILLON RD BARBERTON,OH44203	OUTPATIENT PHYSICIAN CLINIC
24	24 - MENTOR MEDICAL OFFICE 7060 WAYSIDE DR MENTOR,OH44060	OUTPATIENT PHYSICIAN CLINIC
25	25 - CLEVELAND CLINIC SUMMIT OPHTHALMOLOGY 1 PARK WEST BLVD STE 150 AKRON,OH44320	OUTPATIENT PHYSICIAN CLINIC
26	26 - CLEVELAND CLINIC ADMINISTRATIVE CAMPUS 3275 SCIENCE PARK DR BLDG 5 BEACHWOOD,OH44122	OUTPATIENT PHYSICIAN CLINIC
27	27 - OHIO RENAL CARE CLEVELAND EAST 2429 MARTIN LUTHER KING JR DR CLEVELAND,OH44104	DIALYSIS CENTER
28	28 - COMMUNITY PEDIATRICS 8254 MAYFIELD RD CHESTERLAND,OH44026	OUTPATIENT PHYSICIAN CLINIC
29	29 - OHIO RENAL CARE GROUP AMHERST 1168 CLEVELAND AVE AMHERST,OH44001	DIALYSIS CENTER
30	30 - CLEVELAND CLINIC CANCER CENTERS 509 W MCPHERSON HIGHWAY CLYDE,OH43410	OUTPATIENT PHYSICIAN CLINIC
31	31 - MENTOR REHABILITATION AND SPORTS THERAPY 7533 CENTER ST MENTOR,OH44060	OUTPATIENT PHYSICIAN CLINIC
32	32 - MADISON MEDICAL OFFICE 2999 MCMACKIN RD MADISON,OH44057	OUTPATIENT PHYSICIAN CLINIC
33	33 - CCF GASTROENTEROLOGY 7530 FREDLE DR CONCORD,OH44077	OUTPATIENT PHYSICIAN CLINIC
34	34 - ASHLAND OPHTHALMOLOGYSUGARBUSH EYE AND 21 SUGARBUSH CT ASHLAND,OH44805	OUTPATIENT PHYSICIAN CLINIC
35	35 - OLMSTED TOWNSHIP PRIMARY CARE 27089 BAGLEY RD OLMSTED TOWNSHIP,OH44138	OUTPATIENT PHYSICIAN CLINIC
36	36 - CLEVELAND CLINIC SUPERIOR MEDICAL CARE 1959 COOPER FOSTER PARK RD AMHERST,OH44053	DIAGNOSTIC CENTER
37	37 - COMMUNITY PEDIATRICS 2001 CROCKER RD WESTLAKE,OH44145	OUTPATIENT PHYSICIAN CLINIC
38	38 - OHIO RENAL CARE GROUP WESTLAKE 26024 DETROIT AVE WESTLAKE,OH44145	DIALYSIS CENTER
39	39 - MAYFIELD VILLAGE PEDIATRICS 6559 WILSON MILLS RD STE101-D MAYFIELD VILLAGE,OH44143	OUTPATIENT PHYSICIAN CLINIC
40	40 - WILLOUGHBY HILLS BEHAVIORAL HEALTH 2785 SOM CENTER RD WILLOUGHBY HILLS,OH44094	OUTPATIENT PHYSICIAN CLINIC
41	41 - SOUTH RUSSELL FAMILY PRACTICE 5192 CHILLICOTHE RD SOUTH RUSSELL,OH44022	OUTPATIENT PHYSICIAN CLINIC
42	42 - MARYMOUNT REHABILITATION AND SPORTS THER 2525 EAST ROYALTON RD BROADVIEW HEIGHTS,OH44147	OUTPATIENT PHYSICIAN CLINIC
43	43 - OHIO RENAL CARE GROUP WEST 14670 SNOW RD BROOKPARK,OH44142	DIALYSIS CENTER
44	44 - SOUTH POINTE HOSPITAL MEDICAL OFFICE 20050 HARVARD RD WARRENSVILLE HEIGHTS,OH44122	OUTPATIENT PHYSICIAN CLINIC
45	45 - OHIO RENAL CARE GROUP HERITAGE 1160 E BROAD ST ELYRIA,OH44035	DIALYSIS CENTER
46	46 - WADSWORTH PRIMARY CARE ONE PARK CENTER DR WADSWORTH,OH44281	OUTPATIENT PHYSICIAN CLINIC
47	47 - CLEVELAND CLINIC LYNDHURST CAMPUS 1950 RICHMOND RD LYNDHURST,OH44124	OUTPATIENT PHYSICIAN CLINIC
48	48 - OHIO RENAL CARE GROUP EUCLID 26450 EUCLID AVE EUCLID,OH44132	DIALYSIS CENTER
49	49 - NORTH RIDGEVILLE MEDICAL OFFICE 35105 CENTER RIDGE RD NORTH RIDGEVILLE,OH44039	OUTPATIENT PHYSICIAN CLINIC
50	50 - OHIO RENAL CARE GROUP OHIO ACUTES 2500 METROHEALTH DR CLEVELAND,OH44109	DIALYSIS CENTER
51	51 - CHARDON REHABILITATION AND SPORTS THERAP 325 CENTER ST CHARDON,OH44024	OUTPATIENT PHYSICIAN CLINIC
52	52 - OHIO RENAL CARE GROUP SOLON 6020 ENTERPRISE PKWY SOLON,OH44139	DIALYSIS CENTER
53	53 - BEDFORD DIALYSIS CENTER 5035 RICHMOND RD BEDFORD HEIGHTS,OH44146	DIALYSIS CENTER
54	54 - CLEVELAND CLINIC DIABETES AND ENDOCRINOL 3733 PARK EAST DR STE 105 BEACHWOOD,OH44122	OUTPATIENT PHYSICIAN CLINIC
55	55 - OHIO RENAL CARE GROUP FARNSWORTH 3764 PEARL RD CLEVELAND,OH44109	DIALYSIS CENTER
56	56 - SUMMIT OPHTHALMOLOGY 1587 BOETTLER RD GREEN,OH44685	OUTPATIENT PHYSICIAN CLINIC
57	57 - CANFIELD ORTHOPAEDICS AND REHABILITATION 3736 BOARDMAN CANFIELD RD CANFIELD,OH44406	OUTPATIENT PHYSICIAN CLINIC
58	58 - OHIO RENAL CARE GROUP MENTOR 8840 TYLER BLVD MENTOR,OH44060	DIALYSIS CENTER
59	59 - MOHICAN EYE CENTER 484 PARK AVENUE WEST MANSFIELD,OH44906	OUTPATIENT PHYSICIAN CLINIC
60	60 - SAGAMORE HILLS MEDICAL CENTER I 863 WEST AURORA RD SAGAMORE HILLS,OH44067	OUTPATIENT PHYSICIAN CLINIC
61	61 - OHIO RENAL CARE GROUP ELYRIA 5316 HOAG DR SHEFFIELD,OH44035	DIALYSIS CENTER
62	62 - CLEVELAND CLINIC COLE EYE OF STREETSBORO 9424 STATE RT 14 STREETSBORO,OH44241	OUTPATIENT PHYSICIAN CLINIC
63	63 - OHIO RENAL CARE GROUP LAKEWOOD 13900 DETROIT RD LAKEWOOD,OH44109	DIALYSIS CENTER
64	64 - OHIO RENAL CARE GROUP WHITE POND 690 WHITE POND DR AKRON,OH44320	DIALYSIS CENTER
65	65 - MADISON REHABILITATION AND SPORTS THERAP 2622 HUBBARD RD MADISON,OH44057	OUTPATIENT PHYSICIAN CLINIC
66	66 - WELLINGTON MEDICAL OFFICE 805 PATRIOT DR UNIT E WELLINGTON,OH44090	OUTPATIENT PHYSICIAN CLINIC
67	67 - OHIO RENAL CARE GROUP WADSWORTH 1160 WILLIAMS RESERVE BLVD WADSWORTH,OH44281	DIALYSIS CENTER
68	68 - OBERLIN OPHTHALMOLOGY 309 WEST LORAIN ST OBERLIN,OH44074	OUTPATIENT PHYSICIAN CLINIC
69	69 - MACEDONIA EXPRESS AND OUTPATIENT CARE 8210 MACEDONIA COMMONS BLVD MACEDONIA,OH44056	OUTPATIENT PHYSICIAN CLINIC
70	70 - LIBERTY FAMILY MEDICINE 571 E TURKEYFOOT LAKE RD AKRON,OH44319	OUTPATIENT PHYSICIAN CLINIC
71	71 - MOHICAN EYE CENTER 637 NORTH UNION ST LOUDONVILLE,OH44842	OUTPATIENT PHYSICIAN CLINIC
72	72 - COLE EYE - TERMAN PRACTICE 32901 STATION ST SOLON,OH44139	OUTPATIENT PHYSICIAN CLINIC
73	73 - OHIO RENAL CARE GROUP GARFIELD HEIGHTS 9729 GRANGER RD GARFIELD HTS,OH44125	DIALYSIS CENTER
74	74 - BELDEN CENTER 4677 FULTON DRIVE NW CANTON,OH44718	OUTPATIENT PHYSICIAN CLINIC
75	75 - OHIO RENAL CARE GROUP SOUTHPOINT DIALYS 4200 WARRNESVILLE CENTER RD STE 100 WARRENSVILLE HTS,OH44122	DIALYSIS CENTER
76	76 - OHIO RENAL CARE GROUP CUYAHOGA FALLS 320 BROADWAY ST E E CUYAHOGA FALLS,OH44221	DIALYSIS CENTER
77	77 - THE LANGSTON HUGHES CENTER CLEVELAND CLI 2390 E 79TH ST CLEVELAND,OH44104	OUTPATIENT PHYSICIAN CLINIC
78	78 - BRECKSVILLE EXPRESS CARE 8805 BRECKSVILLE RD BRECKSVILLE,OH44141	OUTPATIENT PHYSICIAN CLINIC
79	79 - STOW-FALLS MEDICAL OUTPATIENT CENTER 857 GRAHAM RD STOW,OH44221	OUTPATIENT PHYSICIAN CLINIC
80	80 - SAGAMORE HILLS MEDICAL OFFICE II 885 WEST AURORA RD SAGAMORE HILLS,OH44067	OUTPATIENT PHYSICIAN CLINIC
81	81 - INDEPENDENCE CANCER CENTER 6100 WEST CREEK RD INDEPENDENCE,OH44131	OUTPATIENT PHYSICIAN CLINIC
82	82 - NPCS - BEACHWOOD 26110 EMERY RD WARRENSVILLE HEIGHTS,OH44128	OUTPATIENT PHYSICIAN CLINIC
83	83 - ACCESS TO CARE 29000 AURORA RD SOLON,OH44139	OUTPATIENT PHYSICIAN CLINIC
84	84 - ASHTABULA COUNTY MEDICAL CENTER 2422 LAKE AVE ASHTABULA,OH44004	OUTPATIENT PHYSICIAN CLINIC
85	85 - BOARDMAN STAR IMAGING 7067 TIFFANY BLVD YOUNGSTOWN,OH44512	DIAGNOSTIC CENTER
86	86 - CCF GASTROENTEROLOGY 3700 PARK EAST DR BEACHWOOD,OH44122	OUTPATIENT PHYSICIAN CLINIC
87	87 - CENTER FOR ARTHRITIS 1716 NORTH RD SE WARREN,OH44484	OUTPATIENT PHYSICIAN CLINIC
88	88 - CHARLESTON AREA MEDICAL CENTER 1201 WASHINGTON ST EAST STE 100 CHARLESTON,WV25301	OUTPATIENT PHYSICIAN CLINIC
89	89 - CLEVELAND CLINIC FAMILY MEDICINE 19300 DETROIT AVE ROCKY RIVER,OH44116	OUTPATIENT PHYSICIAN CLINIC
90	90 - CLEVELAND CLINIC HEART & VASCULAR 1400 WEST MAIN ST BELLEVUE HOSPITAL BELLEVUE,OH44811	OUTPATIENT PHYSICIAN CLINIC
91	91 - CLEVELAND CLINIC STAR IMAGING 1449 BOARDMAN-CANFIELD RD YOUNGSTOWN,OH44512	DIAGNOSTIC CENTER
92	92 - CLUB VIEW VISION CENTER OPTOMETRIC 1650 E MANSFIELD ST BUCYRUS,OH44820	OUTPATIENT PHYSICIAN CLINIC
93	93 - COLE EYE INSTITUTE 2000 AUBURN DR STE 100 BEACHWOOD,OH44122	OUTPATIENT PHYSICIAN CLINIC
94	94 - COLUMBUS STAR IMAGING 1550 KENNY RD COLUMBUS,OH43212	DIAGNOSTIC CENTER
95	95 - COLUMBUS STAR IMAGING 921 JASONWAY AVE COLUMBUS,OH43214	DIAGNOSTIC CENTER
96	96 - COLUMBUS STAR IMAGING BEECHER 425 BEECHER RD COLUMBUS,OH43230	DIAGNOSTIC CENTER
97	97 - DAYTON STAR IMAGING 5529 FAR HILLS AVE DAYTON,OH45429	DIAGNOSTIC CENTER
98	98 - DOWNTOWN EXPRESS CARE 315 EUCLID AVE STE 2 CLEVELAND,OH44114	OUTPATIENT PHYSICIAN CLINIC
99	99 - KINDRED HEALTH CARE CLEVELAND 11900 FAIRHILL RD CLEVELAND,OH44120	OUTPATIENT PHYSICIAN CLINIC
100	100 - LAKEWEST MEDICAL BUILDING 36100 EUCLID AVE STE 280 WILLOUGHBY,OH44094	OUTPATIENT PHYSICIAN CLINIC
101	101 - LAKEWOOD FAMILY MEDICINE - ROCKPORT 11851 DETROIT AVE LAKEWOOD,OH44107	OUTPATIENT PHYSICIAN CLINIC
102	102 - LAKEWOOD PROFESSIONAL BUILDING 14601 DETROIT AVE LAKEWOOD,OH44107	OUTPATIENT PHYSICIAN CLINIC
103	103 - LORAIN ORTHOPAEDICS 5800 COOPER FOSTER PARK RD LORAIN,OH44053	OUTPATIENT PHYSICIAN CLINIC
104	104 - NILES STAR IMAGING 652 YOUNGSTOWN WARREN RD NILES,OH44446	DIAGNOSTIC CENTER
105	105 - ROCKSIDE MEDICAL CENTER 6701 ROCKSIDE RD INDEPENDENCE,OH44131	OUTPATIENT PHYSICIAN CLINIC
106	106 - SLEEP DISORDER CENTER AT FAIRHILL 11203 STOKES BLVD CLEVELAND,OH44104	DIAGNOSTIC CENTER
107	107 - SLEEP DISORDERS CENTER 24901 COUNTRY CLUB BLVD NORTH OLMSTED,OH44070	DIAGNOSTIC CENTER
108	108 - SLEEP DISORDERS CENTER 3750 ORANGE PL BEACHWOOD,OH44122	DIAGNOSTIC CENTER
109	109 - SLEEP DISORDERS CENTER 8971 WILCOX DR TWINSBURG,OH44087	DIAGNOSTIC CENTER
110	110 - SLEEP DISORDERS CENTER 1825 LORAIN BLVD ELYRIA,OH44035	DIAGNOSTIC CENTER
111	111 - SLEEP DISORDERS CENTER 5051 WEST CREEK RD INDEPENDENCE,OH44131	DIAGNOSTIC CENTER
112	112 - SLEEP DISORDERS CENTER 3122 EASTPOINTE DR MEDINA,OH44256	DIAGNOSTIC CENTER
113	113 - SLEEP DISORDERS CENTER 5785 HEISLEY RD MENTOR,OH44060	DIAGNOSTIC CENTER
114	114 - VALLEY CITY FAMILY MEDICINE 6605 CENTER RD VALLEY CITY,OH44280	OUTPATIENT PHYSICIAN CLINIC
115	115 - WEST VALLEY MEDICAL 20455 LORAIN RD 301 FAIRVIEW PARK,OH44126	OUTPATIENT PHYSICIAN CLINIC
116	116 - WILLOUGHBY HILLS REHABILITATION AND SPOR 29017 CHARDON RD WILLOUGHBY HILLS,OH44094	OUTPATIENT PHYSICIAN CLINIC
117	117 - WOOSTER MILLTOWN SPECIALTY & SURGERY CEN 721 EAST MILLTOWN RD WOOSTER,OH44691	OUTPATIENT PHYSICIAN CLINIC
118	118 - WOOSTER WOMEN'S HEALTH CENTER 1739 CLEVELAND RD WOOSTER,OH44691	OUTPATIENT PHYSICIAN CLINIC

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	CCF PROVIDES MEDICALLY NECESSARY SERVICES TO ALL PATIENTS, REGARDLESS OF RACE, COLOR, CREED, GENDER OR COUNTRY OF NATIONAL ORIGIN AND WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. CCF HAS A FINANCIAL ASSISTANCE POLICY THAT IS AMONG THE MOST GENEROUS IN NORTHEAST OHIO. THIS POLICY APPLIES TO ALL CCF FACILITIES, AND THE AMOUNT OF CARE PROVIDED UNDER THE POLICY IS DETERMINED BY NEED AND IS NOT LIMITED OR RATIONED BY BUDGETED AMOUNTS. UNDER THE POLICY, CCF PROVIDES FREE CARE TO INDIVIDUALS WITHOUT INSURANCE WITH INCOMES UP TO 250% OF THE FEDERAL POVERTY LEVEL AND DISCOUNTED CARE UP TO 400% OF THE FEDERAL POVERTY LEVEL. IN ADDITION, THE POLICY CONTAINS ADDITIONAL WAYS TO QUALIFY BASED ON FINANCIAL OR MEDICAL NEED. UNLIKE THE FINANCIAL ASSISTANCE POLICIES OF MOST HOSPITALS, THE CCF POLICY APPLIES TO BOTH HOSPITAL CHARGES AND CERTAIN PROFESSIONAL FEES FOR SERVICES PROVIDED BY CCF EMPLOYED PHYSICIANS.
PART I, LINE 7:	THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM A COST ACCOUNTING SYSTEM. IN OTHER CATEGORIES, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THAT CATEGORY.
PART I, LINE 7G:	CCF EMPLOYS ITS PHYSICIANS, THEREFORE THE ASSOCIATED COSTS AND CHARGES RELATING TO THESE PHYSICIAN SERVICES ARE INCLUDED IN ALL RELEVANT CATEGORIES OF PART I.
PART I, LN 7 COL(F):	THE PROPORTIONATE SHARE OF TOTAL JV EXPENSES AND BAD DEBT EXPENSES ARE FACTORED IN FOR PURPOSES OF CALCULATING THE PERCENTAGES.
PART I, LINE 6A	SCH H PART I LINE 6A - AN ANNUAL COMMUNITY BENEFIT REPORT IS PREPARED FOR THE HEALTH SYSTEM AS A WHOLE, WHICH INCLUDES THE PARENT ORGANIZATION AND RELATED AFFILIATES.
PART I, LINE 7	THE NET COMMUNITY BENEFIT EXPENSE FIGURE REPORTED FOR UNREIMBURSED MEDICAID IS INCLUSIVE OF CCF'S HCAP ASSESSMENT OF $15,184,369.
PART I, LINE 7	NOTE THAT THE TOTAL AMOUNT OF FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS OF $676,216,057 AS REPORTED ON PART I, LINE 7 DIFFERS FROM THE TOTAL COMMUNITY BENEFIT FOR CLEVELAND CLINIC AS REPORTED AS A COMPONENT OF THE OVERALL SYSTEM'S COMMUNITY BENEFIT REPORT. THE AMOUNT DIFFERS IN TWO RESPECTS: 1) IRS DOES NOT CONSIDER COMMUNITY BUILDING ACTIVITIES AS REPORTED IN PART II TO BE COMMUNITY BENEFIT WHERE THESE ACTIVITIES ARE INCLUDED IN COMMUNITY BENEFIT PER CHA GUIDELINES, AND2) THE PROPORTIONATE SHARE OF JOINT VENTURE COMMUNITY BENEFIT IS INCLUDED IN LINE 7.
PART I, LINE 2	SELECT FACILITIES HAVE THEIR OWN FINANCIAL ASSISTANCE POLICIES, WHICH COMPLY WITH ALL 501(R) REGULATIONS.
PART II, COMMUNITY BUILDING ACTIVITIES:	CLEVELAND CLINIC ADDRESSES VARIOUS COMMUNITY CONCERNS, INCLUDING HEALTH IMPROVEMENT, POVERTY, WORKFORCE DEVELOPMENT, AND ACCESS TO HEALTH CARE. CLEVELAND CLINIC DEVOTES EMPLOYEE TIME AND TALENT TO PARTICIPATE IN COMMUNITY COLLABORATION BOARDS, HEALTH ADVOCACY PROGRAMS, AND PHYSICAL IMPROVEMENT PROJECTS TO PROMOTE THE HEALTH OF THE COMMUNITIES THE ORGANIZATION SERVES.
PART III, LINE 2:	ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS, NOT INCLUDED IN BAD DEBT EXPENSE.
PART III, LINE 4:	SEE EXPLANATION OF IMPLICIT PRICE CONCESSIONS IN FOOTNOTE #3 ON PG. 13 OF THE AUDITED FINANCIAL STATEMENTS
PART III, LINE 8:	MEDICARE ALLOWABLE COSTS ARE CALCULATED USING A COST-TO-CHARGE RATIO.CCF HAS USED THE CHA METHODOLOGY FOR REPORTING COMMUNITY BENEFIT SINCE 2004 AS IT WAS THE EMERGING COMMUNITY BENEFIT REPORTING STANDARD AND NOW HAS BEEN ADOPTED IN LARGE PART BY THE IRS FOR 990 REPORTING PURPOSES. THE CHA MODEL DOES NOT INCLUDE MEDICARE SHORTFALL AS COMMUNITY BENEFIT.
PART III, LINE 9B:	YES, CLEVELAND CLINIC HAS A WRITTEN DEBT COLLECTION POLICY. IT IS OUR POLICY NOT TO PURSUE COLLECTION PRACTICES AGAINST PATIENTS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE PROGRAMS OR BEFORE REASONABLE EFFORTS HAVE BEEN MADE TO MAKE SUCH DETERMINATION. IN CERTAIN CASES IT MAY NOT BE EASILY DETERMINED WHETHER OR NOT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE; HOWEVER, IF AFTER COLLECTION PRACTICES HAVE BEGUN IT LATER BECOMES KNOWN THAT A PATIENT QUALIFIES, THE COLLECTION EFFORTS CEASE. ADDITIONALLY, OUR EXTERNAL THIRD-PARTY (COLLECTION) AGENCIES ARE TRAINED ON OUR FINANCIAL ASSISTANCE POLICY AND ASSIST A PATIENT IN NEED BY SUPPLYING OUR APPLICATION FOR FINANCIAL ASSISTANCE.
PART III, LINE 5, 6, & 7	IN ADDITION TO THE MEDICARE PROGRAMS REFLECTED IN THE COST REPORTS, CCF INCURS COSTS AND RECEIVES REIMBURSEMENT FOR OTHER MEDICARE ELIGIBLE SERVICES. THE TOTAL REVENUE RECEIVED AND COSTS ASSOCIATED WITH THE ADDITIONAL MEDICARE SERVICES ARE $853,943,932 AND $1,211,630,005 RESPECTIVELY. THIS RESULTS IN ADDITIONAL MEDICARE SHORTFALL OF $357,686,073 WHICH, ADDED TO THE SHORTFALL OF $39,415,319 AS REPORTED ON THE COST REPORTS BRINGS THE TOTAL MEDICARE SHORTFALL TO $397,101,392.
PART VI, LINE 2:	IN ADDITION TO THE CHNA PROCESS, CCF'S INSTITUTES AND DEPARTMENTS MAY GATHER, ANALYZE, AND REVIEW RELEVANT HEALTH STATISTICS AND DEMOGRAPHIC DATA FOR THE COMMUNITY FOR THAT PARTICULAR FACILITY'S COMMUNITY. THE DATA IS USED TO EVALUATE POTENTIAL NEW OR REVISED HEALTH SERVICES THAT CCF MAY PROVIDE TO PARTICULAR GROUPS OF PATIENTS WITHIN THE COMMUNITIES IT SERVES.
PART VI, LINE 3:	INFORMING THE PUBLIC THAT FINANCIAL ASSISTANCE IS AVAILABLE IS AN IMPORTANT ELEMENT OF OUR FINANCIAL ASSISTANCE PROGRAM AND THE CLEVELAND CLINIC CONTINUOUSLY STRIVES TO IMPROVE ITS COMMUNICATIONS WITH PATIENTS ON THE AVAILABILITY OF FINANCIAL ASSISTANCE. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE CLEVELAND CLINIC WEBSITE. ALL PATIENT BILLS INCLUDE DETAILED INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY AND AN INSERT DESCRIBING THE FINANCIAL ASSISTANCE PROGRAM IS INCLUDED WITH BILLING STATEMENTS. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE THROUGHOUT CCF, INCLUDING IN PATIENT REGISTRATION AREAS, ONLINE, AND WITH FINANCIAL COUNSELORS WHO ARE PRESENT ON-SITE AT EACH CLEVELAND CLINIC HOSPITAL AND OHIO FAMILY HEALTH CENTER TO ASSIST PATIENTS IN QUALIFYING FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND FINANCIAL ASSISTANCE. A DESCRIPTION OF THE POLICY IS ALSO INCLUDED IN OUR INSURANCE AND BILLING INFORMATION PATIENT BROCHURE, WHICH IS AVAILABLE AT REGISTRATION DESKS AND WITH FINANCIAL COUNSELORS.
PART VI, LINE 4:	THE CLEVELAND CLINIC'S COMMUNITY IS DEFINED BY BOTH MISSION AND GEOGRAPHY. THE GEOGRAPHIC COMMUNITY IS DEFINED BY THE HOSPITAL FACILITY'S IMMEDIATELY CONTIGUOUS AREAS AS WELL AS THE BROADER SURROUNDING COUNTIES/REGIONS FROM WHICH THE MAJORITY OF DISCHARGED INPATIENTS RESIDE. ADDITIONALLY, THE COMMUNITY INCLUDES PATIENTS WHO REQUIRE THE EXPERTISE AND SPECIALIZED SERVICES OF THE CLEVELAND CLINIC. THE COMMUNITY FOR MEDICAL RESEARCH AND EDUCATION IS THE PUBLIC AT LARGE.
PART VI, LINE 5:	ONE OF THE HALLMARKS OF A CHARITABLE ORGANIZATION IS THAT THE ORGANIZATION SERVES A BROAD, INDEFINITE CHARITABLE CLASS. ONE OF THE KEY INDICATORS THAT AN ORGANIZATION SERVES THE BROADER COMMUNITY IS CONTROL OF THE ORGANIZATION BY INDEPENDENT COMMUNITY LEADERS. CCF AND ITS NORTHEAST OHIO REGIONAL HOSPITAL GOVERNING BOARDS ARE MADE UP OF MEMBERS OF THE COMMUNITY WHO DIRECT AND GUIDE MANAGEMENT IN CARRYING OUT THE MISSION OF CCF AND ITS SUBORDINATES. TRUSTEES/DIRECTORS ARE SELECTED ON THE BASIS OF THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS BENEFICIAL TO THE CLEVELAND CLINIC AND THE HEALTH SYSTEM AND ARE NOT COMPENSATED FOR THEIR SERVICES.ANOTHER HALLMARK OF A CHARITABLE ORGANIZATION IS THAT SURPLUS FUNDS ARE USED TO FURTHER CHARITABLE PURPOSES AND ACTIVITIES. SURPLUS FUNDS FOR CCF AND ITS SUBORDINATES ARE REINVESTED AND USED TO CARRY OUT THE ORGANIZATION'S EXEMPT MISSION -- PATIENT CARE, RESEARCH, AND EDUCATION.
PART VI, LINE 6:	CLEVELAND CLINIC IS THE PARENT ORGANIZATION OF THE HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM CONSISTING OF AN ACADEMIC MEDICAL CENTER, MEDICAL SCHOOL, COMMUNITY HOSPITALS, FAMILY HEALTH CENTERS, VARIOUS ANCILLARY SERVICES, AND A LARGE GROUP OF EMPLOYED PHYSICIANS AND PHYSICIAN RESEARCHERS.
PART VI, LINE 7	AFTER FILING THE FORM 990, A COPY OF THE CLEVELAND CLINIC FOUNDATION'S SCHEDULE H IS SUBMITTED TO THE STATE OF OHIO.

Schedule H (Form 990) 2018

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
THE CLEVELAND CLINIC FOUNDATION

Employer identification number
34-0714585

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) ALICE FLAHERTY EXCELLENCE IN NURSING SCHOLARSHIP FUND INC 24179 AMBOUR DR NORTH OLMSTED,OH44070	47-0974372	501(C)(3)	10,000				SUPPORT EDUCATIONAL ACTIVITIES
(2) AMERICAN CANCER SOCIETY 10501 EUCLID AVE CLEVELAND,OH44106	13-1788491	501(C)(3)	554,775				HEALTHCARE RESEARCH & EDUCATION
(3) AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVE DALLAS,TX75231	13-5613797	501(C)(3)	124,463				HEALTHCARE RESEARCH & EDUCATION
(4) AMERICAN LIVER FOUNDATION 39 BROADWAY 27TH FL NEW YORK,NY10006	36-2883000	501(C)(3)	10,000				HEALTHCARE RESEARCH & EDUCATION
(5) AMERICAN LUNG ASSOCIATION 1740 BROADWAY NEW YORK,NY10019	13-1632524	501(C)(3)	15,000				HEALTHCARE RESEARCH & EDUCATION
(6) AMERICAN NATIONAL RED CROSS 431 18TH ST NW WASHINGTON,DC20006	53-0196605	501(C)(3)	10,000				COMMUNITY SUPPORT
(7) ARTHRITIS FOUNDATION 1330 WEST PEACHTREE ST NW ATLANTA,GA30309	58-1341679	501(C)(3)	10,500				HEALTHCARE RESEARCH & EDUCATION
(8) BEACHWOOD CHAMBER OF COMMERCE 23355 MERCANTILE RD BEACHWOOD,OH44122	34-1684237	501(C)(6)	7,000				COMMUNITY SUPPORT
(9) BOYS AND GIRLS CLUBS OF CLEVELAND 6114 BROADWAY AVE CLEVELAND,OH44127	34-0770686	501(C)(3)	15,000				COMMUNITY SUPPORT
(10) BURTEN BELL CARR DEVELOPMENT INC 7201 KINSMAN RD CLEVELAND,OH44104	34-1657533	501(C)(3)	10,000				COMMUNITY SUPPORT
(11) BUSINESS VOLUNTEERS UNLIMITED 1300 E 9TH ST STE 1805 CLEVELAND,OH44114	34-1724581	501(C)(3)	10,000				COMMUNITY SUPPORT
(12) CASE WESTERN RESERVE UNIVERSITY 2040 ADELBERT RD CLEVELAND,OH44106	34-1018992	501(C)(3)	8,500				SUPPORT EDUCATIONAL ACTIVITIES
(13) CITY CLUB OF CLEVELAND 850 EUCLID AVE 2ND FL CLEVELAND,OH44114	34-0144897	501(C)(3)	26,898				COMMUNITY SUPPORT
(14) CITY OF CLEVELAND 601 LAKESIDE AVE CLEVELAND,OH44114	34-6000646	501(C)(1)	28,019				COMMUNITY SUPPORT
(15) CITY OF LAKEWOOD 12650 DETROIT AVE LAKEWOOD,OH44107	34-6001633	501(C)(1)	500,000				COMMUNITY SUPPORT
(16) CLEVELAND CENTER FOR ARTS AND TECHNOLOGY 3634 EUCLID AVE NO 100 CLEVELAND,OH44115	27-1193704	501(C)(3)	10,000				SUPPORT EDUCATIONAL ACTIVITIES
(17) CLEVELAND INTERNATIONAL FILM FESTIVAL INC 2510 MARKET AVE CLEVELAND,OH44113	34-1262368	501(C)(3)	10,000				COMMUNITY SUPPORT
(18) CLEVELAND MUSEUM OF NATURAL HISTORY 1 WADE OVAL DR CLEVELAND,OH44106	34-0714338	501(C)(3)	8,000				COMMUNITY SUPPORT
(19) CLEVELAND SCHOOL OF SCIENCE & MEDICINE 2075 STOKES BLVD CLEVELAND,OH44106	34-3740643	501(C)(3)	10,000				SUPPORT EDUCATIONAL ACTIVITIES
(20) COLLEGE NOW GREATER CLEVELAND INC 50 PUBLIC SQUARE STE 1800 CLEVELAND,OH44113	34-6580096	501(C)(3)	10,500				SUPPORT EDUCATIONAL ACTIVITIES
(21) COMMUNITY WEST FOUNDATION 800 SHARON DR STE C WESTLAKE,OH44145	34-1456398	501(C)(3)	27,000				COMMUNITY SUPPORT
(22) CROHNS & COLITIS FOUNDATION OF AMERICA 23366 COMMERCE PARK RD BEACHWOOD,OH44122	13-6193105	501(C)(3)	21,500				HEALTHCARE RESEARCH & EDUCATION
(23) CUYAHOGA COMMUNITY COLLEGE FOUNDATION 700 CARNEGIE AVE CLEVELAND,OH44115	23-7320719	501(C)(3)	11,000				SUPPORT EDUCATIONAL ACTIVITIES
(24) DANCING CLASSROOMS NORTHEAST OHIO 1085 ROCKSIDE RD STE 6 PARMA,OH44134	26-2300532	501(C)(3)	23,000				COMMUNITY SUPPORT
(25) DEMOCRACY COLLABORATIVE FOUNDATION INC 1422 EUCLID AVE STE 1652 CLEVELAND,OH44115	20-0387511	501(C)(3)	10,000				COMMUNITY SUPPORT
(26) ESPERANZA INC 4115 BRIDGE AVE CLEVELAND,OH44113	34-1403492	501(C)(3)	20,000				SUPPORT EDUCATIONAL ACTIVITIES
(27) FAIRFAX RENAISSANCE DEVELOPMENT CORPORATION 8111 QUINCY AVE STE 100 CLEVELAND,OH44104	34-1706856	501(C)(3)	237,715				COMMUNITY SUPPORT
(28) FAMICOS FOUNDATION INC 1325 ANSEL RD CLEVELAND,OH44106	34-1053534	501(C)(3)	22,000				COMMUNITY SUPPORT
(29) FATIMA FAMILY CENTER 6600 LEXINGTON AVE CLEVELAND,OH44103	26-1323950	501(C)(3)	20,000				COMMUNITY SUPPORT
(30) GATHERING PLACE 23300 COMMERCE PARK BEACHWOOD,OH44122	34-1879035	501(C)(3)	32,500				COMMUNITY SUPPORT
(31) GIRL SCOUTS OF LAKE ERIE COUNCIL 19201 VILLAVIEW RD CLEVELAND,OH44119	34-0714415	501(C)(3)	10,000				COMMUNITY SUPPORT
(32) GREATER CLEVELAND FOOD BANK INC 15500 S WATERLOO RD CLEVELAND,OH44110	34-1292848	501(C)(3)	15,254				COMMUNITY SUPPORT
(33) GREATER CLEVELAND HABITAT FOR HUMANITY 2110 W 110TH ST CLEVELAND,OH44102	31-1209423	501(C)(3)	15,000				COMMUNITY SUPPORT
(34) JDRF INTERNATIONAL 26 BROADWAY 15TH FL NEW YORK,NY10004	23-1907729	501(C)(3)	5,750				HEALTHCARE RESEARCH & EDUCATION
(35) KEEP MEMORY ALIVE 888 W BONNEVILLE AVE LAS VEGAS,NV89106	88-0515534	501(C)(3)	80,500				HEALTHCARE RESEARCH & EDUCATION
(36) KIDNEY FOUNDATION OF OHIO INC 2831 PROSPECT AVE CLEVELAND,OH44115	34-0827748	501(C)(3)	5,700				HEALTHCARE RESEARCH & EDUCATION
(37) LEUKEMIA & LYMPHOMA SOCIETY 3 INTERNATIONAL DR STE 200 RYE BROOK,NY10573	13-5644916	501(C)(3)	83,500				HEALTHCARE RESEARCH & EDUCATION
(38) MARCH OF DIMES FOUNDATION 614 SUPERIOR AVE NW CLEVELAND,OH44113	13-1846366	501(C)(3)	24,250				HEALTHCARE RESEARCH & EDUCATION
(39) MEDWISH INTERNATIONAL 17325 EUCLID AVE CLEVELAND,OH44112	34-1903712	501(C)(3)	10,000	3,090,522	ESTIMATED VALUE	MEDICAL SUPPLIES	PATIENT CARE
(40) MEDWORKS 1950 RICHMOND RD LYNDHURST,OH44124	26-3858369	501(C)(3)	30,000				HEALTHCARE RESEARCH & EDUCATION
(41) NAMI GREATER CLEVELAND 2012 W 25TH ST STE 600 CLEVELAND,OH44113	20-2254268	501(C)(3)	10,000				HEALTHCARE RESEARCH & EDUCATION
(42) NATIONAL ASSOCIATION OF HISPANIC NURSES INV 1500 SUNDAY DR STE 102 RALEIGH,NC27607	91-1010677	501(C)(3)	10,000				COMMUNITY SUPPORT
(43) NATIONAL KIDNEY FOUNDATION 30 E 33RD ST NEW YORK,NY10016	13-1673104	501(C)(3)	20,000				HEALTHCARE RESEARCH & EDUCATION
(44) NATIONAL MULTIPLE SCLEROSIS SOCIETY 1422 EUCLID AVE CLEVELAND,OH44115	13-5661935	501(C)(3)	10,000				HEALTHCARE RESEARCH & EDUCATION
(45) NORTH UNION FARMERS MARKET 13212 SHAKER SQUARE STE 302 CLEVELAND,OH44120	34-1812026	501(C)(3)	18,500				COMMUNITY SUPPORT
(46) OPEN DOORS INC 3311 PERKINS AVE CLEVELAND,OH44114	04-3697716	501(C)(3)	20,000				COMMUNITY SUPPORT
(47) OPERATION EXODUS USA PO BOX 568 LANCASTER,NY14086	20-2076659	501(C)(3)	99,800				COMMUNITY SUPPORT
(48) OUTRUN OVARIAN CANCER PO BOX 40332 BAY VILLAGE,OH44140	80-0093560	501(C)(3)	17,500				HEALTHCARE RESEARCH & EDUCATION
(49) RAINEY INSTITUTE 1523 E 55TH ST CLEVELAND,OH44144	34-6555952	501(C)(3)	15,000				COMMUNITY SUPPORT
(50) REGIONAL TRANSIT AUTHORITY PO BOX 6566 CLEVELAND,OH44101	34-1170830	501(C)(1)	125,000				COMMUNITY SUPPORT
(51) RONALD MCDONALD HOUSE OF CLEVELAND INC 10415 EUCLID AVE CLEVELAND,OH44106	34-1269123	501(C)(3)	17,000				HEALTHCARE RESEARCH & EDUCATION
(52) SAINT MARTIN DE PORRES HIGH SCHOOL 6111 LAUSCHE AVE CLEVELAND,OH44103	52-2401852	501(C)(3)	44,973				SUPPORT EDUCATIONAL ACTIVITIES
(53) SOUTH EUCLID UNITED CHURCH OF CHRIST 4217 BLUESTONE RD SOUTH EUCLID,OH44121	34-0714615	501(C)(3)	291,667				COMMUNITY SUPPORT
(54) SPIRIT OF CLEVELAND INC 334 EUCLID AVE CLEVELAND,OH44114	34-1823509	501(C)(3)	7,620				COMMUNITY SUPPORT
(55) ST EDWARD HIGH SCHOOL 13500 DETROIT AVE LAKEWOOD,OH44107	34-0737808	501(C)(3)	7,500				SUPPORT EDUCATIONAL ACTIVITIES
(56) SUSAN G KOMEN BREAST CANCER FOUNDATION 26210 EMERY RD STE 307 CLEVELAND,OH44128	34-1793460	501(C)(3)	17,500				HEALTHCARE RESEARCH & EDUCATION
(57) THE CLEVELAND CLINIC EDUCATIONAL FOUNDATION 9500 EUCLID AVE CLEVELAND,OH44195	34-0714553	501(C)(3)	19,298,390				HEALTHCARE RESEARCH & EDUCATION
(58) THE CLEVELAND FOUNDATION 1422 EUCLID AVE STE 1300 CLEVELAND,OH44115	34-0714588	501(C)(3)	250,000				COMMUNITY SUPPORT
(59) THE CLEVELAND ORCHESTRA 11001 EUCLID AVE CLEVELAND,OH44106	34-0714468	501(C)(3)	12,500				COMMUNITY SUPPORT
(60) THE DIVERSITY CENTER OF NORTHEAST OHIO 3659 GREEN RD STE 220 CLEVELAND,OH44122	20-1968761	501(C)(3)	5,700				COMMUNITY SUPPORT
(61) THE GREATER CLEVELAND HEALTHCARE ASSOCIATION 1226 HURON RD CLEVELAND,OH44115	34-0714649	501(C)(3)	25,014				HEALTHCARE RESEARCH & EDUCATION
(62) THE SALVATION ARMY 440 W NYACK RD WEST NYACK,NY10994	13-5562351	501(C)(3)	15,000				COMMUNITY SUPPORT
(63) THE VILLAGE AT MARYMOUNT 5200 MARYMOUNT VILLAGE DR GARFIELD HTS,OH44125	20-5652595	501(C)(3)	15,000				HEALTHCARE RESEARCH & EDUCATION
(64) TOWARDS EMPLOYMENT INC 1255 EUCLID AVE STE 300 CLEVELAND,OH44115	34-1578831	501(C)(3)	10,000				COMMUNITY SUPPORT
(65) TRANSPLANT HOUSE OF CLEVELAND 2007 E 115TH ST APT 1 CLEVELAND,OH44106	27-2834616	501(C)(3)	12,000				HEALTHCARE RESEARCH & EDUCATION
(66) UNITED WAY OF GREATER CLEVELAND 1331 EUCLID AVE CLEVELAND,OH44115	34-6516654	501(C)(3)	10,000				COMMUNITY SUPPORT
(67) UNIVERSITY CIRCLE INCORPORATED 10831 MAGNOLIA DR CLEVELAND,OH44106	34-0823464	501(C)(3)	7,500				COMMUNITY SUPPORT
(68) URSULINE PIAZZA 7801 DETROIT AVE CLEVELAND,OH44102	37-1655740	501(C)(3)	10,000				HEALTHCARE RESEARCH & EDUCATION
(69) YOUTH OPPORTUNITIES UNLIMITED 1361 EUCLID AVE CLEVELAND,OH44115	34-1381135	501(C)(3)	10,500				COMMUNITY SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) SCHOLARSHIPS	199	8,217,202
(2) FELLOWSHIPS	1531	72,203,214
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	CCF CONTRIBUTES FINANCIAL AND IN-KIND SUPPORT TO OTHER TAX EXEMPT ORGANIZATIONS AND AGENCIES THAT FURTHER THE CCF MISSION OF PATIENT CARE, RESEARCH, AND EDUCATION. THESE ORGANIZATIONS ARE TO USE THE SUPPORT TO STRENGTHEN THE OVERALL HEALTH OF THE COMMUNITIES WE SERVE.
SCHEDULE I, PART III	THE SCHOLARSHIPS AND FELLOWSHIPS LISTED ARE IN FURTHERANCE OF THE CLEVELAND CLINIC FOUNDATION'S MISSION TO INCREASE KNOWLEDGE, AWARENESS, AND QUALITY OF PATIENT CARE AND RESEARCH THROUGH EDUCATION.

Schedule I (Form 990) 2018

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2018

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DONLEY MD BRIAN DIRECTOR, CHIEF OF STAFF (PART-YR)	(i) (ii)	1,364,489 ------------- 0	0 ------------- 0	903,039 ------------- 0	27,500 ------------- 0	300,456 ------------- 0	2,595,484 ------------- 0	0 ------------- 0
2MIHALJEVIC MD TOMISLAV DIRECTOR, PRESIDENT & CEO	(i) (ii)	2,678,622 ------------- 0	0 ------------- 0	299,381 ------------- 0	27,500 ------------- 0	18,193 ------------- 0	3,023,696 ------------- 0	0 ------------- 0
3WIEDEMANN MD HERBERT DIRECTOR, CHIEF OF STAFF	(i) (ii)	910,877 ------------- 0	0 ------------- 0	74,237 ------------- 0	-182,971 ------------- 0	18,650 ------------- 0	820,793 ------------- 0	0 ------------- 0
4BARSOUM MD WAEL DIRECTOR, FLA PRES	(i) (ii)	0 ------------- 1,039,904	0 ------------- 0	0 ------------- 97,685	0 ------------- 27,500	0 ------------- 13,501	0 ------------- 1,178,590	0 ------------- 0
5FRANCO MD KATHLEEN DIRECTOR, PHYSICIAN	(i) (ii)	271,140 ------------- 0	0 ------------- 0	9,608 ------------- 0	-96,742 ------------- 0	17,675 ------------- 0	201,681 ------------- 0	0 ------------- 0
6SPIRO MD TIMOTHY DIRECTOR, PHYSICIAN	(i) (ii)	598,511 ------------- 0	0 ------------- 0	65,444 ------------- 0	27,500 ------------- 0	17,304 ------------- 0	708,759 ------------- 0	0 ------------- 0
7ERZURUM MD SERPIL CHAIR, LERNER RESEARCH INSTITUTE	(i) (ii)	621,000 ------------- 0	0 ------------- 0	39,650 ------------- 0	58,517 ------------- 0	1,500 ------------- 0	720,667 ------------- 0	0 ------------- 0
8GLASS STEVEN C CFO & TREASURER	(i) (ii)	1,508,404 ------------- 0	0 ------------- 0	146,308 ------------- 0	24,583 ------------- 0	18,411 ------------- 0	1,697,706 ------------- 0	0 ------------- 0
9HARRINGTON MICHAEL CAO & CONTROLLER	(i) (ii)	757,222 ------------- 0	0 ------------- 0	70,987 ------------- 0	27,500 ------------- 0	19,193 ------------- 0	874,902 ------------- 0	0 ------------- 0
10MEEHAN MICHAEL J RECORDING SECRETARY	(i) (ii)	330,793 ------------- 0	0 ------------- 0	35,622 ------------- 0	-67,709 ------------- 0	17,522 ------------- 0	316,228 ------------- 0	0 ------------- 0
11OBLANDER JASON ASST. SECRETARY	(i) (ii)	209,595 ------------- 0	0 ------------- 0	3,674 ------------- 0	5,837 ------------- 0	15,407 ------------- 0	234,513 ------------- 0	0 ------------- 0
12PEACOCK WILLIAM CHIEF OF OPERATIONS	(i) (ii)	1,630,154 ------------- 0	0 ------------- 0	140,295 ------------- 0	27,545 ------------- 0	18,161 ------------- 0	1,816,155 ------------- 0	0 ------------- 0
13ROWAN DAVID SECRETARY, CHIEF LEGAL OFFICER	(i) (ii)	1,480,468 ------------- 0	0 ------------- 0	150,884 ------------- 0	27,500 ------------- 0	19,347 ------------- 0	1,678,199 ------------- 0	0 ------------- 0
14SABANEGH MD EDMUND PRESIDENT, CC MAIN CAMPUS	(i) (ii)	910,582 ------------- 0	0 ------------- 0	89,468 ------------- 0	27,500 ------------- 0	17,777 ------------- 0	1,045,327 ------------- 0	0 ------------- 0
15YOUNG MD JAMES P CHIEF ACADEMIC OFFICER	(i) (ii)	812,284 ------------- 0	0 ------------- 0	88,263 ------------- 0	27,500 ------------- 0	18,233 ------------- 0	946,280 ------------- 0	0 ------------- 0
16SURI MD RAKESH CEO CCAD	(i) (ii)	1,255,255 ------------- 0	0 ------------- 0	828,047 ------------- 0	27,500 ------------- 0	152,702 ------------- 0	2,263,504 ------------- 0	0 ------------- 0
17SVENSSON MD LARS CHAIR OF HEART & VASCULAR INST	(i) (ii)	1,489,979 ------------- 0	0 ------------- 0	148,811 ------------- 0	27,500 ------------- 0	18,086 ------------- 0	1,684,376 ------------- 0	0 ------------- 0
18BROOKS MD PETER PHYSICIAN	(i) (ii)	1,254,311 ------------- 0	0 ------------- 0	124,643 ------------- 0	207,115 ------------- 0	17,504 ------------- 0	1,603,573 ------------- 0	0 ------------- 0
19COSGROVE MD DELOS FORMER CEO	(i) (ii)	4,601,492 ------------- 0	0 ------------- 0	4,116,692 ------------- 0	-32,819 ------------- 0	2,946 ------------- 0	8,688,311 ------------- 0	0 ------------- 0
20HUSTON ANN CHIEF STRATEGY OFFICER	(i) (ii)	183,479 ------------- 0	0 ------------- 0	1,164,859 ------------- 0	23,992 ------------- 0	16,277 ------------- 0	1,388,607 ------------- 0	0 ------------- 0
21MARTIN MD DANIEL COLE EYE INSTITUTE CHAIRMAN	(i) (ii)	1,288,761 ------------- 0	0 ------------- 0	126,495 ------------- 0	27,500 ------------- 0	18,053 ------------- 0	1,460,809 ------------- 0	0 ------------- 0
22NAJM MD HANI PHYSICIAN	(i) (ii)	1,515,904 ------------- 0	0 ------------- 0	148,311 ------------- 0	27,500 ------------- 0	18,411 ------------- 0	1,710,126 ------------- 0	0 ------------- 0
23HAMILTON THOMAS FORMER OFFICER	(i) (ii)	421,075 ------------- 0	0 ------------- 0	24,784 ------------- 0	9,453 ------------- 0	18,240 ------------- 0	473,552 ------------- 0	0 ------------- 0
24MCHUGH LINDA FORMER OFFICER	(i) (ii)	807,357 ------------- 0	0 ------------- 0	78,295 ------------- 0	27,068 ------------- 0	17,458 ------------- 0	930,178 ------------- 0	0 ------------- 0
25HAHN MD JOSEPH FORMER OFFICER (RETIRED)	(i) (ii)	148,394 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	148,394 ------------- 0	148,394 ------------- 0
26LYTLE MD BRUCE FORMER KEY EMPLOYEE (RETIRED)	(i) (ii)	118,200 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	118,200 ------------- 0	118,200 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 1A

LISTED BENEFITS THE BENEFITS CHECKED IN PART I, QUESTION 1A, WERE PROVIDED TO CERTAIN PERSONS LISTED IN FORM 990, PART VII, SECTION A ON AN EXCEPTION BASIS ONLY FOR AN APPROPRIATE BUSINESS PURPOSE. ANY REIMBURSEMENT OF THE EXPENSES LISTED MET CLEVELAND CLINIC'S WRITTEN POLICY REGARDING SUBSTANTIATION AND REIMBURSEMENT. WHERE REQUIRED BY IRS RULES AND REGULATIONS, THE LISTED BENEFITS WERE INCLUDED IN TAXABLE INCOME.

PART I, LINES 4A-B

SCHEDULE J, LINE 4A SEVERANCE ANN HUSTON RECEIVED A SEVERANCE PAYMENT OF $1,156,000. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DELOS COSGROVE - PARTICIPATED IN AND RECEIVED PAYMENTS FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. FOR MEDICARE TAX PURPOSES, $3,926,119 OF INCOME REPORTED IN PART VII AND SCHEDULE J REPRESENT THE AMOUNT VESTED IN THE PLANS. THE FOLLOWING INDIVIDUALS PARTICIPATE IN A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND/OR A QUALIFIED DEFINED BENEFIT PLAN AND THE ANNUAL INCREASE OR DECREASE IN THE ACTUARIAL VALUE IS INCLUDED IN SCHEDULE J, PART II, COLUMN C, RETIREMENT AND OTHER DEFERRED COMPENSATION: DELOS M. COSGROVE - $60,319 DECREASE, SERPIL ERZURUM - $31,017 INCREASE, KATHLEEN FRANCO - $124,092 DECREASE, STEVEN GLASS - $2,917 DECREASE, THOMAS HAMILTON - $18,047 DECREASE, LINDA MCHUGH - $432 DECREASE, MICHAEL J. MEEHAN - $95,209 DECREASE, JASON OBLANDER - $638 DECREASE, WILLIAM PEACOCK $45 INCREASE AND HERBERT WIEDEMANN $210,471 DECREASE.

Schedule J (Form 990) 2018

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
THE CLEVELAND CLINIC FOUNDATION

Employer identification number
34-0714585

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	67756DAY2	05-29-2013	309,434,914	BOND 2013: REFUND 2004B, 2003A AND FACILITY IMPROVEMENTS		X		X		X
B	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	67756A3Z3	05-09-2012	519,383,182	BOND 2012: REFUND 2009, 2003A AND FACILITY IMPROVEMENTS		X		X		X
C	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	677561HU9	11-02-2011	208,951,439	BOND 2011A: REFUND 2003A SERIES		X		X		X
D	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	NONEAVAIL	11-02-2011	41,120,000	BOND 2011B: REFUND 1992A & B AND 1989 SERIES		X		X		X
	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	677561FV9	08-25-2009	807,007,320	BONDS 2009A&B: REFUND 2008B, FACILITY CONSTRUCTION, EQUIPPING AND IMPROVING		X		X		X
	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	67756AJ37	10-15-2008	670,000,000	BOND 2008B: REFUND 06A, 04A, AND 01A; FACILITY IMPROVEMENTS		X		X		X
	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	NONEAVAIL	12-21-2017	9,305,000	REFUND SERIES 2002		X		X		X
	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	677561KS0	08-29-2017	939,576,748	REFUND 2008A, 2008B, 2009A, 2009B, 2012A		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	43,347,782		44,599,156		51,767,413		14,740,000
2 Amount of bonds legally defeased ..............	70,000
3 Total proceeds of issue ..................	309,434,914		519,383,182		208,951,439		41,120,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............							2,302,465
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	2,129,301		3,825,815		2,003,385		735,249
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	20,001,498		411,300,530
11 Other spent proceeds .............	287,304,115		104,256,837		206,948,054		38,082,286
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013		2012		2011		2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X			X		X	X
15 Were the bonds issued as part of an advance refunding issue? .....		X	X		X			X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.880 %		0.680 %		1.050 %		1.740 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0.010 %		0.080 %				0.010 %
6 Total of lines 4 and 5 .............	0.880 %		0.760 %		1.050 %		1.750 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.050 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............	X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X			X		X		X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference

Explanation

DATE REBATE COMPUTATION PERFORMED

ISSUER NAME: OHIO HIGHER EDUCATIONAL FACILITY COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 05/29/2018 ISSUER NAME: OHIO HIGHER EDUCATIONAL FACILITY COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 05/09/2017 ISSUER NAME: OHIO HIGHER EDUCATIONAL FACILITY COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 11/01/2016 ISSUER NAME: OHIO HIGHER EDUCATIONAL FACILITY COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 11/02/2016 ISSUER NAME: OHIO HIGHER EDUCATIONAL FACILITY COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 08/25/2014 ISSUER NAME: OHIO HIGHER EDUCATIONAL FACILITY COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 10/15/2018

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
THE CLEVELAND CLINIC FOUNDATION

Employer identification number
34-0714585

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	67756DAY2	05-29-2013	309,434,914	BOND 2013: REFUND 2004B, 2003A AND FACILITY IMPROVEMENTS		X		X		X
B	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	67756A3Z3	05-09-2012	519,383,182	BOND 2012: REFUND 2009, 2003A AND FACILITY IMPROVEMENTS		X		X		X
C	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	677561HU9	11-02-2011	208,951,439	BOND 2011A: REFUND 2003A SERIES		X		X		X
D	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	NONEAVAIL	11-02-2011	41,120,000	BOND 2011B: REFUND 1992A & B AND 1989 SERIES		X		X		X
	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	677561FV9	08-25-2009	807,007,320	BONDS 2009A&B: REFUND 2008B, FACILITY CONSTRUCTION, EQUIPPING AND IMPROVING		X		X		X
	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	67756AJ37	10-15-2008	670,000,000	BOND 2008B: REFUND 06A, 04A, AND 01A; FACILITY IMPROVEMENTS		X		X		X
	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	NONEAVAIL	12-21-2017	9,305,000	REFUND SERIES 2002		X		X		X
	OHIO HIGHER EDUCATIONAL FACILITY COMMISSION	34-6849674	677561KS0	08-29-2017	939,576,748	REFUND 2008A, 2008B, 2009A, 2009B, 2012A		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	43,347,782		44,599,156		51,767,413		14,740,000
2 Amount of bonds legally defeased ..............	70,000
3 Total proceeds of issue ..................	309,434,914		519,383,182		208,951,439		41,120,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............							2,302,465
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	2,129,301		3,825,815		2,003,385		735,249
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	20,001,498		411,300,530
11 Other spent proceeds .............	287,304,115		104,256,837		206,948,054		38,082,286
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013		2012		2011		2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X			X		X	X
15 Were the bonds issued as part of an advance refunding issue? .....		X	X		X			X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.880 %		0.680 %		1.050 %		1.740 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0.010 %		0.080 %				0.010 %
6 Total of lines 4 and 5 .............	0.880 %		0.760 %		1.050 %		1.750 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.050 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............	X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X			X		X		X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference

Explanation

DATE REBATE COMPUTATION PERFORMED

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) D COSGROVE	FORMER PRESIDENT/CEO	INSURANCE PREMIUM PAYMENTS TREATED AS A LOAN		X	229,247	7,444,253		No	Yes		Yes





Total ............... $						7,444,253

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) AMANDA IGEL	FAMILY MEMBER OF TIMOTHY SPIRO, CCF DIRECTOR	58,143	EMPLOYMENT AGREEMENT WITH CCF		No
(2) CHAD BRONSON	FAMILY MEMBER OF KATHLEEN FRANCO, CCF DIRECTOR	48,300	EMPLOYMENT AGREEMENT WITH CCF		No
(3) RYAN OAKLEY	FAMILY MEMBER OF WILLIAM PEACOCK, CCF OFFICER	26,365	EMPLOYMENT AGREEMENT WITH CCF		No
(4) KATHERINE MCHUGH	FAMILY MEMBER OF LINDA MCHUGH, FORMER CCF OFFICER	40,501	EMPLOYMENT AGREEMENT WITH CCF		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....	X	27	297,049	APPRAISAL
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..	X		2,600	SALE COMPARABLE GOODS
5 Clothing and household goods .......	X		18,712	SALE COMPARABLE GOODS
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	201	12,549,028	AVERAGE HIGH/LOW
10 Securities—Closely held stock .	X	2	44,545	COST
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..	X	2	1,041,500	APPRAISAL
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...	X	1	1,379	COST
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( MEDICAL EQUIPMENT )	X	25	239,848	SALE COMPARABLE GOOD
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2018)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 32B:	THE CLEVELAND CLINIC FOUNDATION WILL AT TIMES HIRE INDEPENDENT THIRD PARTIES TO SELL CERTAIN NON-CASH CONTRIBUTIONS SUCH AS AUCTION ITEMS OR REAL ESTATE.

Schedule M (Form 990) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

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.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

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, LOCATED 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 WITH THE SAME MISSION THAT CONTINUES TODAY: BETTER CARE FOR THE SICK, INVESTIGATION OF THEIR PROBLEMS, AND FURTHER EDUCATION OF THOSE WHO SERVE. 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 2018 CLEVELAND CLINIC AND ITS AFFILIATES PROVIDED $969.3 MILLION 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 ON OUR WEBSITE AT CLEVELANDCLINIC.ORG. (COMMUNITY BENEFIT AMOUNTS REPORTED IN THIS PROGRAM SERVICE STATEMENT REFER TO OUR 2018 COMMUNITY CONNECTIONS, BASED ON THE CHA REPORTING METHODOLOGY. SEE FORM 990, SCHEDULE H FOR A RECONCILIATION OF SCHEDULE H TO COMMUNITY BENEFIT REPORTING.) I. PATIENT CARE IN 2018, THE CLEVELAND CLINIC HEALTH SYSTEM INCLUDED AN ACADEMIC MEDICAL CENTER AND 11 COMMUNITY HOSPITALS (AKRON GENERAL MEDICAL CENTER, AVON, EUCLID, FAIRVIEW, HILLCREST, LODI, LUTHERAN, MARYMOUNT, MEDINA, SOUTH POINTE, AND UNION HOSPITALS), AND A SPECIALTY HOSPITAL (CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION) IN NORTHEAST OHIO; ONE HOSPITAL AND ONE HEALTH AND WELLNESS CENTER IN FLORIDA; AND A CENTER FOR BRAIN HEALTH IN LAS VEGAS, NEVADA. CLEVELAND CLINIC HEALTH SYSTEM IS DEDICATED TO THE COMMUNITIES WE SERVE 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 OUR FINANCIAL ASSISTANCE EFFORTS AND AS A LEADING MEDICAID PROVIDER IN OHIO, WE PROVIDE HEALTHCARE TO THOSE WHO OTHERWISE COULD NOT AFFORD IT. IN 2018, CLEVELAND CLINIC RECORDED 1,294 TOTAL STAFFED BEDS, 118,317 EMERGENCY VISITS, 80,094 SURGICAL CASES, 51,514 ADMISSIONS, AND MORE THAN 6.6 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, BARIATRIC & METABOLIC, COLE EYE, DERMATOLOGY & PLASTIC SURGERY, DIGESTIVE DISEASE & SURGERY, EMERGENCY SERVICES, ENDOCRINOLOGY & METABOLISM, GENOMICS, GLICKMAN UROLOGICAL & KIDNEY, HEAD & NECK, MILLER FAMILY HEART & VASCULAR, IMAGING, MEDICINE, NEUROLOGICAL, NURSING, OB/GYN & WOMEN'S HEALTH, ORTHOPAEDIC & RHEUMATOLOGY, PATHOLOGY & LABORATORY MEDICINE, PEDIATRIC & CHILDREN'S HOSPITAL, RESPIRATORY, TAUSSIG CANCER, & WELLNESS & PREVENTATIVE MEDICINE. 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 2018. OVERALL, CLEVELAND CLINIC WAS AMONG THE NATION'S BEST HOSPITALS, EARNING THE NO. 2 RANKING. FOR THE 24TH CONSECUTIVE YEAR, CLEVELAND CLINIC RANKED BEST IN THE NATION FOR CARDIOLOGY AND HEART SURGERY, EARNING THE NO. 1 SPOT. THE GLICKMAN UROLOGICAL & KIDNEY INSTITUTE RECEIVED THE NO. 1 DISTINCTION IN UROLOGY AND NO. 2 IN NEPHROLOGY. TEN OTHER CLEVELAND CLINIC SPECIALTIES ALSO RANKED IN THE TOP 10. NINE OTHER CLEVELAND CLINIC SPECIALTIES PLACED IN THE TOP 5 INCLUDING: CANCER, DIABETES & ENDOCRINOLOGY, GASTROENTEROLOGY & GI SURGERY, GERIATRICS, GYNECOLOGY, NEUROLOGY & NEUROSURGERY, ORTHOPEDICS, PULMONOLOGY, AND RHEUMATOLOGY. CLEVELAND CLINIC WAS ALSO RATED "HIGH PERFORMING" IN NINE PROCEDURES AND CONDITIONS. CLEVELAND CLINIC HAS ACHIEVED 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. 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 2018, CLEVELAND CLINIC AND ITS FACILITIES RECEIVED: THE ENVIRONMENTAL EXCELLENCE AWARD, PARTNER FOR CHANGE AWARD, GREENING THE OR LEADERSHIP AWARD, LEADERSHIP CIRCLE AWARD, CLIMATE CIRCLE, PARTNER RECOGNITION AWARD, SYSTEM FOR CHANGE AWARD, AND THE GREEN BUILDING CIRCLE 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 EXCEPTIONAL CIRCUMSTANCES MAY ALSO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THIS 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 $110.8 MILLION IN 2018. 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. 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 175 FACULTY-LEVEL SCIENTISTS ORGANIZED IN THE FOLLOWING DEPARTMENTS: BIOMEDICAL ENGINEERING, CANCER BIOLOGY, CARDIOVASCULAR AND METABOLIC SCIENCES, GENOMIC MEDICINE, INFLAMMATION AND IMMUNITY, NEUROSCIENCES, OPHTHALMIC RESEARCH, PATHOBIOLOGY, 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 240 RESEARCH FELLOWS, 160 GRADUATE STUDENTS AND 200 UNDERGRADUATE STUDENTS.
FORM 990, PART III, PROGRAM SERVICE STATEMENT (CONTINUED)	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 2018, CLEVELAND CLINIC WAS INVOLVED IN APPROXIMATELY 4,000 ACTIVE IRB 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 2018, CLEVELAND CLINIC PROVIDED COMMUNITY BENEFIT IN RESEARCH AT A SUBSIDIZED COST OF MORE THAN $243.4 MILLION, WHICH INCLUDED EXTERNALLY- SPONSORED FUNDING OF $165.7 MILLION. 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. 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 THIS 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 2018, PROVIDED A NET COMMUNITY BENEFIT OF $282.9 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 2018, 1,001 RESIDENTS AND FELLOWS TRAINED IN 77 ACCREDITED TRAINING PROGRAMS, APPROVED BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME), INCLUDING 137 ADVANCED FELLOWS IN 88 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 MORE THAN 1,900 APPLICANTS FOR 32 POSITIONS FOR THE 2018-19 ACADEMIC YEAR. THE PROGRAM'S STUDENTS HAVE MATCHED AT SOME OF THE MOST PRESTIGIOUS HOSPITALS THROUGHOUT THE UNITED STATES AND HAVE CONTRIBUTED 117 PUBLICATIONS TO THE WORLD'S STORE OF SCIENTIFIC KNOWLEDGE BASED ON 2018 CALENDAR YEAR (WHICH INCLUDES PUBLISHED ARTICLES AND ABSTRACT SUBMISSIONS), AND 69 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 2018, 326 MEDICAL STUDENTS FROM 168 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 2018, THE CENTER FOR CONTINUING EDUCATION CERTIFIED 1,738 CME ACTIVITIES THAT OFFERED OVER 13,000 CME CREDITS TO 194,008 PARTICIPANTS. OF THAT NUMBER, 1,344 WERE LIVE COURSES THAT ATTRACTED 80,006 PARTICIPANTS. CLEVELAND CLINIC IS ONE OF THE LARGEST PROVIDERS OF ONLINE CME AMONG THE NATION'S ACADEMIC MEDICAL CENTERS. THE CENTER'S WEBSITE HAD 171 ACTIVITIES THAT ATTRACTED 29,148 ACTIVITY VIEWERS. JOURNAL CME CONTINUES TO REACH A LARGE NUMBER OF LEARNERS, AWARDING MORE THAN 85,000 CERTIFICATES TO CLEVELAND CLINIC JOURNAL OF MEDICINE (CCJM) PARTICIPANTS. IN 2018, THE CENTER ISSUED 182,832 CERTIFICATES FOR ALL ACTIVITIES COMBINED. -THE CCJM ENJOYED A CIRCULATION OF MORE THAN 123,000 COPIES AND RANKED NO. 2 IN READERSHIP AMONG JOURNALS DIRECTED TO OFFICE-BASED INTERNISTS AND CARDIOLOGISTS. EACH YEAR, THE PRINT AND ONLINE VERSIONS ARE READ OR ACCESSED BY APPROXIMATELY 3.5 MILLION PEOPLE AROUND THE WORLD. IN 2018 THE CCJM WEBSITE RECORDED 7,123,661 PAGE VIEWS FROM 5,200,985 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 11 IN-HOUSE ALLIED HEALTH PROGRAMS AND HAS 51 AFFILIATED PROGRAMS WITH REGIONAL ACADEMIC INSTITUTIONS. IN 2018, CLEVELAND CLINIC HEALTH SYSTEM HOSTED MORE THAN 370,000 CLINICAL ROTATION HOURS FOR OVER 1,100 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 2018, 918 INTERNATIONAL PHYSICIANS AND MEDICAL STUDENTS TRAVELED TO CLEVELAND CLINIC TO PARTICIPATE IN OBSERVERSHIPS; 245 PHYSICIANS ATTENDED SYMPOSIA HELD AT CLEVELAND CLINIC IN PATIENT EXPERIENCE, CARDIOLOGY, COLORECTAL SURGERY, SPINE SURGERY, GASTROENTEROLOGY, LEUKEMIA, UROLOGY, CONGENITAL HEART DISEASE, BREAST CANCER, AND OBESITY; AND STAFF TRAVELED TO MORE THAN 15 COUNTRIES TO SHARE CLINICAL AND SURGICAL INNOVATIONS. 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 OUR 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 2018, THE HEALTH SYSTEM'S UNPAID MEDICAID COSTS WERE $438.1 MILLION (THIS FIGURE IS INCLUSIVE OF AN HCAP ASSESSMENT OF $6.2 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 2018 AT A COST OF $21.7 MILLION. COMMUNITY OUTREACH PROGRAMS THE CLEVELAND CLINIC HEALTH SYSTEM IS ACTIVELY ENGAGED IN A BROAD ARRAY OF COMMUNITY OUTREACH PROGRAMS, PROVIDING A TOTAL NET COMMUNITY BENEFIT OF $37.5 MILLION. THESE PROGRAMS ARE DESIGNED TO SERVE THE VULNERABLE AND AT-RISK POPULATIONS IN OUR COMMUNITIES. OUR WELL-ESTABLISHED OUTREACH PROGRAMS RANGE FROM FREE WELLNESS INITIATIVES, HEALTH SCREENINGS, CLINICAL SERVICES, AND EDUCATION 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 2018, SOME HIGHLIGHTS INCLUDED: - WELLNESS INITIATIVES IN THE AREAS OF DISEASE/INJURY PREVENTION AND HEALTHY BEHAVIORAL CHANGE, INCLUDING TOBACCO CESSATION, NUTRITION IMPROVEMENT AND EXERCISE. -COMMUNITY CLASSES OFFERED HEALTH EDUCATION ON CHRONIC DISEASE MANAGEMENT IN THE AREAS OF HEART DISEASE, STROKE, CANCER, DIABETES, ASTHMA AND BRAIN HEALTH. OUR HOSPITALS AND FAMILY HEALTH CENTERS PROVIDED CLASSES FOR HEALTHY SENIOR AND YOUTH LIFESTYLES. NAVIGATORS WORKED WITH COMMUNITY RESIDENTS TO OBTAIN NEEDED RESOURCES. -EDUCATION AND COMMUNITY SERVICES ADDRESSED AREAS OF INFANT MORTALITY, TEEN PARENTING, LEAD POISONING, DOMESTIC VIOLENCE AND TRAUMA. PROGRAMS WERE PROVIDED TO SCHOOLS, FAITH-BASED ORGANIZATIONS, COMMUNITY CENTERS, COLLABORATING CITIES AND COUNTIES.
FORM 990, PART III, PROGRAM SERVICE STATEMENT (CONTINUED)	- OPIOID EPIDEMIC COMMUNITY COLLABORATIONS PROVIDED UNIFIED RESPONSES AND RESOURCE ALLOCATION IN AN EFFORT TO REDUCE OVERDOSES. -HEALTH FAIRS PROVIDED THOUSANDS OF PEOPLE WITH FREE HEALTH SCREENINGS. THE CLEVELAND CLINIC MINORITY MEN'S HEALTH FAIR, CELEBRATING SISTERHOOD, TU FAMILIA, PINK AND BEYOND AND NEIGHBORHOOD FAIRS EDUCATED COMMUNITY MEMBERS ON THE BENEFITS OF PREVENTATIVE CARE. -CLEVELAND CLINIC PROVIDED NO-COST CLINICAL CARE TO UNDER- AND UNINSURED FAMILIES AT COMMUNITY SITES, INCLUDING LANGSTON HUGHES HEALTH & EDUCATION CENTER AND THE PEDIATRIC MOBILE UNIT, WHICH PROVIDED WELLNESS SERVICES TO OUR COMMUNITIES. IN ADDITION, LABORATORY AND VISION SERVICES WERE DONATED TO CLEVELAND-AREA ORGANIZATIONS. -HEALTHY COMMUNITY INITIATIVES CONTINUED TO CONNECT RESIDENTS WITH LOCAL RESOURCES IN A COLLABORATION TO STRENGTHEN COMMUNITIES THROUGH NEIGHBORHOOD WELLNESS ACTIVITIES COMPETITIONS, ACADEMIC ACHIEVEMENT AND CAREER PREPAREDNESS. -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. 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	RONALD WEINBERG, CCF DIRECTOR & WILLIAM PEACOCK, CCF OFFICER - BUSINESS DEBORAH CRAWFORD, CCF DIRECTOR & PATRICK AULETTA, CCF DIRECTOR - BUSINESS RONALD WEINBERG, 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 TRUSTEES. 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 (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. IN ADDITION TO POSTING ON GUIDESTAR, 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	CCF HAS ADOPTED A CONFLICT OF INTEREST ("COI") POLICY CONSISTENT WITH THE MODEL IRS COI POLICY. IT APPLIES TO DIRECTORS, OFFICERS AND TRUSTEES OF CCF AND ALL ITS AFFILIATES, BOTH EXEMPT AND TAXABLE. UNDER THE BOARD OF DIRECTORS POLICY AND PROCEDURES FOR DEALING WITH CONFLICT OF INTEREST ISSUES (THE POLICY), A TRUSTEE OR DIRECTOR WHO HAS A CONFLICT OF INTEREST WITH RESPECT TO A PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT MUST REFRAIN FROM VOTING ON ANY MATTER RELATING TO THE CONTRACT, TRANSACTION, OR ARRANGEMENT. IN ADDITION, THE TRUSTEES, DIRECTORS AND OFFICERS MUST ANNUALLY DISCLOSE ANY INTERESTS AS DEFINED IN THE POLICY THAT MAY BE CONSIDERED A POTENTIAL CONFLICT OF INTEREST. FAILURE TO TIMELY REPLY IS TO BE ADDRESSED BY THE COMMITTEE UNDER THE POLICY. THE TRUSTEES, OFFICERS AND DIRECTORS HAVE A CONTINUING OBLIGATION TO NOTIFY THE CHIEF GOVERNANCE OFFICER AT ANY TIME DURING THE YEAR IF ANY OF THEIR DISCLOSURES CHANGE OR IF A NEW DISCLOSURE IS REQUIRED UNDER THE POLICY. THE BOARD CONFLICT OF INTEREST COMMITTEE MEETS FOUR TIMES A YEAR AND REVIEWS THE DISCLOSURES, ANY PROPOSED ARRANGEMENTS THAT MAY INVOLVE A POTENTIAL CONFLICT OF INTEREST, AND DOCUMENTS THEIR 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 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 AND KEY EMPLOYEES, 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 XI, LINE 9:	GIFTS AND BEQUESTS 88,792,685. RETIREMENT BENEFITS ADJUSTMENT 28,397,884. CHANGE IN INTERESTS IN FOUNDATIONS 606,250. DONATED CAPITAL AND ASSETS RELEASED FROM RESTRICTION FOR CAPITAL PURPOSES 591,499. EQUITY AND OTHER TRANSFERS -255,345. NET ASSETS RELEASED FROM RESTRICTION FOR OPERATIONS -42,076,412. TRANSFERS OF NET ASSETS -74,212,895. NET INVESTMENT INCOME -9,063,175. ROUNDING 1.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE CLEVELAND CLINIC FOUNDATION

Employer identification number

34-0714585

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) ADEO LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 46-5704174	TECHNOLOGY SERVICES	OH	5,814	173,371	THE CLEVELAND CLINIC FOUNDATION
(2) ADVANCED INFUSION SERVICES LTD 1 HOME CARE PLACE AKRON,OH44320 34-1847339	HOME INFUSION SERVICES	OH	28,259	181,463	VISITING NURSE SERVICE INC
(3) CC CHINA LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 20-5776477	INACTIVE	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(4) CC WEB SOLUTIONS LLC 6801 BRECKSVILLE RD INDEPENDENCE,OH44131 26-3222020	DOMAIN HOLDING COMPANY	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(5) CCF AMBULATORY SURGERY CENTERS LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 34-1939710	HEALTH CARE SERVICES	OH	17,841,855	392,486	THE CLEVELAND CLINIC FOUNDATION
(6) CCF HOTEL SERVICES LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 34-0666034	HOTEL OPERATIONS	OH	34,659,045	133,139,807	THE CLEVELAND CLINIC FOUNDATION
(7) CHV HOME MEDICAL EQUIPMENT CO LLC 1 HOME CARE PLACE AKRON,OH44320 20-4760456	DURABLE MEDICAL EQUIPMENT	OH	376,380	0	VISITING NURSE SERVICE INC
(8) CLEVELAND CLINIC CARE COORDINATION LLC 6801 BRECKSVILLE RD INDEPENDENCE,OH44131 45-5282492	HEALTH CARE SERVICES	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(9) CLEVELAND CLINIC FLORIDA CONCIERGE MEDICINE LLC 1301 EAST BROWARD BLVD STE 330 FT LAUDERDALE,FL33301 82-3186835	MEDICAL SERVICES	FL	0	0	CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION)
(10) CLEVELAND CLINIC FLORIDA NAPLES LLC 2950 CLEVELAND CLINIC BLVD WESTON,FL33331 31-1741150	HEALTH CARE SERVICES	FL	0	0	CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION)
(11) CLEVELAND CLINIC GLOBAL SOLUTIONS LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 26-3666730	HELATH CARE SERVICES & IP LICENSING	OH	3,600,448	22,978,513	THE CLEVELAND CLINIC FOUNDATION
(12) CLEVELAND CLINIC MEDICARE ACO LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 47-1281189	HEALTH CARE SERVICES	OH	0	2,647,096	THE CLEVELAND CLINIC FOUNDATION
(13) CLEVELAND CLINIC OBGYN SPECIALTIES LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 34-1938153	HEALTH CARE SERVICES	OH	6,229,215	0	THE CLEVELAND CLINIC FOUNDATION
(14) CLEVELAND CLINIC WELLNESS ENTERPRISE LLC 1950 RICHMOND ROAD LYNDHURST,OH44124 26-3859233	HEALTH CARE SERVICES	OH	3,438,266	0	THE CLEVELAND CLINIC FOUNDATION
(15) CLINIC MEDICAL SERVICES COMPANY LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 34-1932969	HEALTH CARE SERVICES	OH	56,322,127	0	THE CLEVELAND CLINIC FOUNDATION
(16) CLINIC PHYSICIAN SERVICES COMPANY LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 34-1907574	HEALTH CARE SERVICES	OH	30,071,893	0	THE CLEVELAND CLINIC FOUNDATION
(17) CLINIC REGIONAL PHYSICIANS LLC 25875 SCIENCE PARK DR BEACHWOOD,OH44122 26-2636530	HEALTH CARE SERVICES	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(18) EDWIN SHAW REHAB LLC 330 BROADWAY STREET EAST CUYAHOGA FALLS,OH44221 27-0119182	REHABILITATION FACILITY	OH	-586,129	1,798,164	AKRON GENERAL MEDICAL CENTER
(19) INTELLIS EPM LLC 6801 BRECKSVILLE RD INDEPENDENCE,OH44131 27-0645368	MEDICAL TECHNOLOGY	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(20) IVHR LLC 6801 BRECKSVILLE RD INDEPENDENCE,OH44131 45-4657632	MEDICAL TECHNOLOGY	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(21) MEDINA HEALTH VENTURES LLC 1000 E WASHINGTON STREET MEDINA,OH44256	INACTIVE	OH	0	0	MEDINA HOSPITAL
(22) MERIDIA MEDICAL GROUP LLC 6801 BRECKSVILLE RD INDEPENDENCE,OH44131 34-1898545	INACTIVE	OH	0	0	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
(23) MONTROSE SLEEP CENTER LLC 4125 MEDINA ROAD AKRON,OH44333 20-0494491	HEALTH CARE SERVICES	OH	957,667	986,054	AKRON GENERAL PARTNERS
(24) NEUROOPERATIVE MONITORING LLC 1 AKRON GENERAL AVENUE AKRON,OH44307 30-0746215	INACTIVE	OH	0	0	AKRON GENERAL PARTNERS
(25) NORTHEAST OHIO NEUROLOGICAL ASSOCIATES LLC 6801 BRECKSVILLE RD INDEPENDENCE,OH44131 20-0442351	HEALTH CARE SERVICES	OH	0	0	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
(26) OHIO STAR IMAGING LLC 9500 EUCLID AVENUE CLEVELAND,OH44195	INACTIVE	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(27) PSVW LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 26-1614376	REAL ESTATE HOLDINGS	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(28) REJ HOLDINGS LLC 3050 SCIENCE PARK DRIVE BEACHWOOD,OH44122 27-3245990	REAL ESTATE HOLDINGS	OH	0	0	THE CLEVELAND CLINIC FOUNDATION
(29) TATARA VASCULAR LLC 10000 CEDAR AVE CLEVELAND,OH44106 47-4282964	MEDICAL TECHNOLOGY	DE	0	0	THE CLEVELAND CLINIC FOUNDATION
(30) THE BRENTWOOD CENTER OF EXCELLENCE LLC 6801 BRECKSVILLE RD INDEPENDENCE,OH44131 20-1476092	HEALTH CARE SERVICES	OH	0	0	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION
(31) WOOSTER CLINIC LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 34-1855775	HEALTH CARE SERVICES	OH	46,059,654	59,519	THE CLEVELAND CLINIC FOUNDATION
(32) CLEVELAND CLINIC FLORIDA HOME HEALTHCARE LLC 2950 CLEVELAND CLINIC BLVD WESTON,FL33331 83-2250064	HEALTH CARE SERVICES	FL	0	0	CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION)
(33) UNION HOSPITAL MEDICAL SERVICES LLC 659 BOULEVARD DOVER,OH44622 27-0273520	HEALTH CARE SERVICES	OH	339,916	0	THE UNION HOSPITAL ASSOCIATION
(34) UNION PHYSICIAN SERVICES LLC 659 BOULEVARD DOVER,OH44622 26-4215547	HEALTH CARE SERVICES	OH	12,596,202	0	THE UNION HOSPITAL ASSOCIATION
(35) TUSCARAWAS AMBULATORY SURGERY CENTER LLC 659 BOULEVARD DOVER,OH44622 34-0000100	HEALTH CARE SERVICES	OH	4,533,144	2,348,352	THE UNION HOSPITAL ASSOCIATION

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)COMMUNITY WEST FOUNDATION 800 SHARON DRIVE STE C WESTLAKE,OH44145 34-1456398	ADVANCE THE HEALTH AND WELL-BEING OF THE COMMUNITY	OH	501(C)(3)	LINE 7	N/A		No
(2)THREE ARCHES FOUNDATION 14601 DETROIT AVENUE STE 240 LAKEWOOD,OH44107 34-6519834	SUPPORT LAKEWOOD HOSPITAL ASSOCIATION	OH	501(C)(3)	LINE 12D, III-O	N/A		No
(3)NATIONAL HEALTHCARE RESEARCH & EDUCATION FINANCE CORP 2001 ROSS AVENUE DALLAS,TX75201 31-1707979	SUPPORT CHARITABLE PURPOSES OF HOSPITALS & UNIVERSITIES	TX	501(C)(3)	LINE 12D, III-O	N/A		No
(4)WO WALKER CENTER INC 10700 EUCLID AVENUE CLEVELAND,OH44106 91-1818256	HEALTH CARE SERVICES	OH	501(C)(3)	LINE 12D, III-O	N/A		No
(5)AUXILIARY BOARD OF FAIRVIEW GENERAL HOSPITAL 18101 LORAIN AVENUE CLEVELAND,OH44111 23-7108198	SUPPORT FAIRVIEW HOSPITAL	OH	501(C)(3)	PF	N/A		No
(6)TUSCARAWAS VALLEY REGIONAL CANCER CENTER 659 BOULEVARD DOVER,OH44622 34-0000100	PHYSICIAN HOSPITAL AND ORGANIZAITON	OH	501(C)(3)	LINE 3	N/A		No
(7)CLEVELAND CLINIC PHILANTHROPY (UK) LTD 40 GROSVENOR PLACE LONDON SW1X 7AW UK	SUPPORT HEALTH CARE, RESEARCH, AND EDUCATION	UK	501(C)(3)		N/A		No
(8)UNION HOSPITAL AUXILIARY 659 BOULEVARD DOVER,OH44622 34-1204928	SUPPORT THE UNION HOSPITAL ASSOCIATION	OH	501(C)(3)	LINE 10	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) CCFMHS RENAL CARE COMPANY LTD 9500 EUCLID AVENUE CLEVELAND,OH44195 34-1863789	MEDICAL SERVICES	OH	THE CLEVELAND CLINIC FOUNDATION	RELATED	2,733,255	13,178,548		No		Yes		60.000 %
(2) CLEVELAND HEALTH NETWORK MSO LLC 4700 ROCKSIDE ROAD STE 200 INDEPENDENCE,OH44131 31-1566180	MEDICAL SERVICES	OH	N/A	RELATED		16,541		No		Yes		100.000 %
(3) PROGNOSTIX LLC 10000 CEDAR AVENUE CLEVELAND,OH44106 30-0624422	MEDICAL SERVICES	OH	THE CLEVELAND CLINIC FOUNDATION	RELATED	10,329	6,865		No			No	78.000 %
(4) EXCELERATE STRATEGIC HEALTH SOURCING LLC 9500 EUCLID AVENUE CLEVELAND,OH44195 46-1810992	HEALTH CARE OP & MGMT	DE	THE CLEVELAND CLINIC FOUNDATION	RELATED	44,745	3,954,664		No	-335,027		No	51.000 %
(5) AKRON SURGICAL ASSOC LLC 4125 MEDINA ROAD AKRON,OH44333 01-0672877	AMBULATORY SURGERY CENTER	OH	N/A	N/A	1,040,389	1,849,175		No			No	51.000 %
(6) MEDISTRY LLC 3029 PROSPECT AVENUE CLEVELAND,OH44115 45-4880352	DATA HOSTING & RELATED SVCS	DE	THE CLEVELAND CLINIC FOUNDATION	UNRELATED	-191,331	23,017		No		Yes		55.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) 33 GROSVENOR PLACE LTD 47 ESPLANADE ST HELIER JEI 0BD JE	LEASE HOLDING COMPANY	JE	CLEVELAND CLINIC UK HOLDINGS LTD	C	-365,948,520		100.000 %	Yes
(2) AKRON GENERAL INNOVATIONS INC 1 AKRON GENERAL AVENUE AKRON,OH44307 38-3928798	PARTNERSHIP INVESTMENTS	OH	AKRON GENERAL PARTNERS	C					No
(3) AKRON GENERAL MANAGED CARE ASSOCIATION INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 34-1784985	SUPPORTING SERVICES	OH	AKRON GENERAL MEDICAL CENTER	C				Yes
(4) CCF BOLTON INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 20-4596571	BUSINESS SERVICES	OH	CLINIC MEDICAL SOLUTIONS INC	C				Yes
(5) CCHS INDEMNITY CO LTD 23 LIME TREE BAY BOX 1051 GRAND CAYMAN KY1-1102 CJ 98-0207086	INSURANCE COMPANY	CJ	THE CLEVELAND CLINIC FOUNDATION	C	59,458,379	161,211,932	100.000 %	Yes
(6) CELLX TECHNOLOGIES INC 10000 CEDAR AVENUE CLEVELAND,OH44106 82-2405500	MEDICAL TECHNOLOGY	DE	THE CLEVELAND CLINIC FOUNDATION	C			100.000 %	Yes
(7) CLEVELAND CLINIC CANADA-TORONTO INC 181 BAY STREET BOX818 TORONTO M5J 2T3 CA	HEALTH CARE SERVICES	CA	THE CLEVELAND CLINIC FOUNDATION	C	13,366,909	13,445,532	100.000 %	Yes
(8) CLEVELAND CLINIC EMR INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 20-4856025	MEDICAL SERVICES	OH	CLINIC MEDICAL SOLUTIONS INC	C		1,121,837		Yes
(9) CLEVELAND CLINIC HEALTH SYSTEM PHYSICIAN ORGANIZATION 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 34-1877409	MEDICAL SERVICES	OH	CLINIC MEDICAL SOLUTIONS INC	C	12,508,988	11,549,645		Yes
(10) CLEVELAND CLINIC LONDON LTD 11-12 ST JAMESS SQUARE ST1 3RD LONDON SW1Y 4LB UK	HOSPITAL OPERATING COMPANY	UK	CLEVELAND CLINIC UK HOLDINGS LTD	C	-30,560	30,079,471	100.000 %	Yes
(11) CLEVELAND CLINIC SAUDI ARABIA (A LIMITED LIABILITY COMPANY) PO BOX 340340 RIYADH 11333 SA	MEDICAL SERVICES	SA	THE CLEVELAND CLINIC FOUNDATION	C	27,061,943	44,047,256	100.000 %	Yes
(12) CLEVELAND CLINIC UK HOLDINGS LTD 11-12 ST JAMESS SQUARE ST1 3RD LONDON SW1Y 4LB UK	HOLDING COMPANY	UK	THE CLEVELAND CLINIC FOUNDATION	C	-250,817	729,438,861	100.000 %	Yes
(13) CLEVELAND HEALTH NETWORK 6000 WEST CREEK ROAD STE 20 INDEPENDENCE,OH44131 34-1770780	MEDICAL SERVICES	OH	N/A	C				Yes
(14) CLEVELAND HEALTH NETWORK MANAGED CARE ORGANIZATION 6000 WEST CREEK ROAD STE 20 INDEPENDENCE,OH44131 34-1808138	HEALTH CARE SERVICES	OH	CLEVELAND HEALTH NETWORK	C				Yes
(15) CLINIC MEDICAL SOLUTIONS INC 18101 LORAIN AVENUE CLEVELAND,OH44111 34-1695388	HEALTH CARE SERVICES	OH	THE CLEVELAND CLINIC FOUNDATION	C	13,943,952	4,981,757		Yes
(16) CMCD INC 1000 E WASHINGTON STREET MEDINA,OH44256 34-1256599	REAL ESTATE	OH	MEDINA HOSPITAL	C		311,040	100.000 %	Yes
(17) CORA SENTA TECHNOLOGIES INC 10000 CEDAR AVENUE CLEVELAND,OH44106 82-4335548	INACTIVE	DE	THE CLEVELAND CLINIC FOUNDATION	C					No
(18) CUSTOM ORTHOPAEDIC SOLUTIONS INC 10000 CEDAR AVENUE CLEVELAND,OH44106 27-4838981	MEDICAL TECHNOLOGY	DE	THE CLEVELAND CLINIC FOUNDATION	C					No
(19) ENHALE MEDICAL INC 10000 CEDAR AVENUE CLEVELAND,OH44106 82-1613340	SLEEP APNEA TREATMENT	DE	THE CLEVELAND CLINIC FOUNDATION	C		1,463,357	100.000 %	Yes
(20) INFUSEON THERAPEUTICS INC 10000 CEDAR AVENUE CLEVELAND,OH44106 46-1776182	SCIENTIFIC RESEARCH	DE	THE CLEVELAND CLINIC FOUNDATION	C	100,842	399,735	100.000 %	Yes
(21) ION-VAC INC 10000 CEDAR AVENUE CLEVELAND,OH44106 46-1560044	SCIENTIFIC RESEARCH	DE	THE CLEVELAND CLINIC FOUNDATION	C		89,231	100.000 %	Yes
(22) LAKEWOOD HEALTHCARE FOUNDATION 14519 DETROIT AVENUE LAKEWOOD,OH44107 34-1574608	HEALTH CARE SERVICES	OH	LAKEWOOD HOSPITAL ASSOCIATION	C				Yes
(23) MCZ INC 1000 E WASHINGTON STREET MEDINA,OH44256 34-1256598	LEASING	OH	MEDINA HOSPITAL	C	7,807	500	100.000 %	Yes
(24) MEDINVEST INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 20-3978297	INACTIVE	OH	CLINIC MEDICAL SOLUTIONS INC	C			100.000 %	Yes
(25) MERIDIA HEALTH VENTURES INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 34-1533871	HEALTH CARE SERVICES	OH	CLEVELAND CLINIC HOME CARE	C			100.000 %	Yes
(26) MERLOT ORTHOPEDIX INC 10000 CEDAR AVENUE CLEVELAND,OH44106 11-3779414	MEDICAL DEVICE MANUFACTURING	DE	THE CLEVELAND CLINIC FOUNDATION	C		64,784	55.120 %	Yes
(27) NEOMEDICS INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 02-0656818	BUSINESS SERVICES	OH	CLINIC MEDICAL SOLUTIONS INC	C			100.000 %	Yes
(28) NEUROTHERAPIA INC 10000 CEDAR AVENUE CLEVELAND,OH44106 47-3977513	MEDICAL TECHNOLOGY	DE	THE CLEVELAND CLINIC FOUNDATION	C		305,130	100.000 %	Yes
(29) OPTOQUEST CORPORATION 10000 CEDAR AVENUE CLEVELAND,OH44106 26-3589643	SCIENTIFIC RESEARCH	DE	THE CLEVELAND CLINIC FOUNDATION	C	61,750	52,610	100.000 %	Yes
(30) PINE FALLS CONDOMINIUM ASSOCIATES INC 6100 WEST CREEK SUITE 25 INDEPENDENCE,OH44131 34-1617589	CONDO RENTALS	OH	THE CLEVELAND CLINIC FOUNDATION	C			75.000 %	Yes
(31) RENOVO BIOSCIENCES INC 10000 CEDAR AVENUE CLEVELAND,OH44106 34-1956569	MEDICAL TECHNOLOGY	DE	RENOVO BIOSCIENCES INC	C	1,003,531	1,418,755	100.000 %	Yes
(32) RENOVO NEURAL INC 10000 CEDAR AVENUE CLEVELAND,OH44106 80-0185146	MEDICAL TECHNOLOGY	DE	THE CLEVELAND CLINIC FOUNDATION	C	148,193		100.000 %	Yes
(33) SHIELD BIOTECH INC 10000 CEDAR AVENUE CLEVELAND,OH44106 46-2880975	MEDICAL TECHNOLOGY	DE	THE CLEVELAND CLINIC FOUNDATION	C			72.000 %	Yes
(34) VIVERE PHARMA INC 10000 CEDAR AVENUE CLEVELAND,OH44106 47-5397125	INACTIVE	DE	THE CLEVELAND CLINIC FOUNDATION	C			100.000 %	Yes
(35) CLEVELAND CLINIC UK FINANCING PLC 11-12 ST JAMESS SQUARE ST1 3RD LONDON SW1Y 4LB UK	FINANCING	UK	CLEVELAND CLINIC UK HOLDINGS LTD	C		524,516,847	100.000 %	Yes
(36) UNION CARE CORPORATION 659 BOULEVARD DOVER,OH44622 34-1556177	INACTIVE	OH	THE UNION HOSPITAL ASSOCIATION	C			100.000 %	Yes
(37) UNION PHARMACEUTICALCARE INC 659 BOULEVARD DOVER,OH44622 04-3588229	HEALTH CARE SERVICES	OH	THE UNION HOSPITAL ASSOCIATION	C	15,157	42,127	100.000 %	Yes
(38) CASHEL NEURAL INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 82-4625105	SCIENTIFIC RESEARCH	DE		C				Yes
(39) NEW COS INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131 82-4828042	SCIENTIFIC RESEARCH	DE		C	1,263,741	519,193		Yes
(40) TMAO INC 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44111 82-4850194	INACTIVE	DE		C				Yes
(41) CHARITABLE REMAINDER TRUSTS (14) C/O 6801 BRECKSVILLE ROAD INDEPENDENCE,OH44131		OH		T				Yes

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CLEVELAND CLINIC CANADA - TORONTO INC	A	100,000	FMV
(2) THE CLEVELAND CLINIC EDUCATIONAL FOUNDATION	B	19,298,390	FMV
(3) EXCELERATE STRATEGIC HEALTH SOURCING LLC	B	765,000	FMV
(4) MEDISTRY LLC	B	82,500	FMV
(5) NEW COS INC	B	104,733	FMV
(6) ENHALE MEDICAL INC	D	2,070,833	FMV
(7) INFUSEON THERAPEUTICS INC	D	196,417	FMV
(8) NEUROTHERAPIA INC	D	209,944	FMV
(9) OPTOQUEST CORPORATION	D	83,964	FMV
(10) RENOVO BIOSCIENCES INC	D	467,492	FMV
(11) CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION	J	293,633	FMV
(12) THE CLEVELAND CLINIC EDUCATIONAL FOUNDATION	J	2,256,745	FMV
(13) CLEVELAND CLINIC MEDICAL SERVICES INC	J	439,728	FMV
(14) FAIRVIEW HOSPITAL	J	483,831	FMV
(15) PARTNERS PHYSICIAN GROUP	J	127,622	FMV
(16) AKRON GENERAL MEDICAL CENTER	K	141,610	FMV
(17) CLEVELAND CLINIC AVON HOSPITAL	K	4,670,941	FMV
(18) CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION	K	3,278,597	FMV
(19) CLINIC MEDICAL SOLUTIONS INC	K	395,956	FMV
(20) FAIRVIEW HOSPITAL	K	1,390,413	FMV
(21) LUTHERAN HOSPITAL	K	585,639	FMV
(22) MARYMOUNT HOSPITAL INC	K	886,369	FMV
(23) MEDINA HOSPITAL	K	1,319,245	FMV
(24) AKRON GENERAL MEDICAL CENTER	L	3,262,802	FMV
(25) CLEVELAND CLINIC AVON HOSPITAL	L	1,101,855	FMV
(26) CLEVELAND CLINIC FLORIDA HEALTH SYSTEM NONPROFIT CORPORATION	L	4,957,000	FMV
(27) CLEVELAND CLINIC NEVADA	L	232,971	FMV
(28) CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION	L	161,268	FMV
(29) CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION	L	6,813,914	FMV
(30) CLEVELAND CLINIC SAUDI ARABIA LLC	L	3,704,000	FMV
(31) CLINIC MEDICAL SOLUTIONS INC	L	1,167,000	FMV
(32) FAIRVIEW HOSPITAL	L	4,032,008	FMV
(33) EXCELERATE STRATEGIC HEALTH SOURCING LLC	L	315,230	FMV
(34) LUTHERAN HOSPITAL	L	1,154,261	FMV
(35) MARYMOUNT HOSPITAL INC	L	1,414,146	FMV
(36) MEDINA HOSPITAL	L	1,392,188	FMV
(37) AKRON GENERAL MEDICAL CENTER	M	277,724	FMV
(38) CLEVELAND CLINIC AVON HOSPITAL	M	552,172	FMV
(39) CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION	M	242,444	FMV
(40) CLEVELAND CLINIC MEDICAL SERVICES INC	M	10,759,000	FMV
(41) FAIRVIEW HOSPITAL	M	433,935	FMV
(42) LODI COMMUNITY HOSPITAL	M	60,302	FMV
(43) LUTHERAN HOSPITAL	M	121,675	FMV
(44) MARYMOUNT HOSPITAL INC	M	411,736	FMV
(45) MEDINA HOSPITAL	M	878,992	FMV
(46) CCHS INDEMNITY COMPANY LTD	P	40,225,680	FMV
(47) THE CLEVELAND CLINIC EDUCATIONAL FOUNDATION	Q	1,127,054	FMV
(48) EXCELERATE STRATEGIC HEALTH SOURCING LLC	Q	2,679,637	FMV
(49) EXCELERATE STRATEGIC HEALTH SOURCING LLC	S	1,520,629	FMV
(50) PROGNOSTIX LLC	S	336,116	FMV
(51) SHIELD BIOTECH INC	S	10,081,248	FMV

Schedule R (Form 990) 2018

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PATIENT CARE, RESEARCH & EDUCATION
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	29
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	24
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	39,017
6	Total number of volunteers (estimate if necessary) .............	6	1,179
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	54,828,485
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	241,311,504	261,657,223
9	Program service revenue (Part VIII, line 2g) .........	5,436,585,308	5,723,660,688
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	188,856,450	148,849,599
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	106,483,355	119,937,216
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	5,973,236,617	6,254,104,726
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	125,681,696	106,912,553
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	3,059,296,529	3,217,788,553
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	2,043,350	1,625,085
b	Total fundraising expenses (Part IX, column (D), line 25) 14,305,948
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	2,395,257,002	2,557,209,646
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	5,582,278,577	5,883,535,837
19	Revenue less expenses. Subtract line 18 from line 12.......	390,958,040	370,568,889
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	10,870,079,986	10,990,906,558
21	Total liabilities (Part X, line 26).............	5,467,933,789	5,561,105,105
22	Net assets or fund balances. Subtract line 21 from line 20.....	5,402,146,197	5,429,801,453

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 5,258,722,543 including grants of $ 106,912,553 ) (Revenue $ 5,723,660,688 )
	SEE PROGRAM SERVICE STATEMENT IN SCHEDULE O.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses5,258,722,543

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	36,046,145	1,137,589	1,144,876

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	6,051,761
d	Related organizations		1d	2,735
e	Government grants (contributions)		1e	118,484,057

f	All other contributions, gifts, grants, and similar amounts not included above		1f	137,118,670

g	Noncash contributions included in lines 1a - 1f:$ 14,194,661
h Total. Add lines 1a-1f.......		261,657,223

		Business Code
2a	NET PATIENT SERVICES	612990	3,247,346,605	3,247,346,605
b	MEDICARE/MEDICAID PAYM	921990	1,936,999,813	1,936,999,813
c	OTHER PROGRAM SERVICES	900099	415,868,347	411,385,334	4,483,013
d	OTHER ANCILLARY SERVIC	900099	54,184,773			54,184,773
e	MANAGEMENT FEES	561000	23,297,208	16,154,355	7,142,853
f	All other program service revenue.		45,963,942	3,261,323	42,702,619
g	Total. Add lines 2a–2f ....		5,723,660,688

3 Investment income (including dividends, interest, and othersimilar amounts) ......			43,622,908			43,622,908
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........			21,685,588			21,685,588
		(ii) Personal	(i) Real
6a	Gross rents		9,489,233
b	Less: rental expenses		0
c	Rental income or (loss)		9,489,233
d	Net rental income or (loss)......			9,489,233			9,489,233
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	239,362	2,568,792,965
b	Less: cost or other basis and sales expenses	1,568,515	2,462,237,121
c	Gain or (loss)	-1,329,153	106,555,844
d	Net gain or (loss).....			105,226,691			105,226,691
8a	Gross income from fundraising events (not including $ 6,051,761of contributions reported on line 1c). See Part IV, line 18 ....
	a		1,391,415
b	Less: direct expenses ...b		2,155,070
c	Net income or (loss) from fundraising events..			-763,655			-763,655
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	INCOME (LOSS) ON INVES		523000	92,689,670		500,000	92,189,670
b	DERIVATIVE INCOME		525990	1,458,519			1,458,519
c	LIFE INSURANCE TRUST		525990	135,325			135,325
d	All other revenue ....			-4,757,464			-4,757,464
e	Total. Add lines 11a–11d ......			89,526,050
12	Total revenue. See Instructions......			6,254,104,726	5,615,147,430	54,828,485	322,471,588

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	25,597,509	25,597,509
2	Grants and other assistance to domestic individuals. See Part IV, line 22	80,420,416	80,420,416
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	894,628	894,628
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	21,806,861	6,537,952	15,268,909
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	1,670,324	133,297	1,537,027
7	Other salaries and wages	2,572,082,476	2,220,561,768	343,391,004	8,129,704
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	167,266,366	144,431,123	22,331,230	504,013
9	Other employee benefits .......	282,767,279	244,113,970	37,751,410	901,899
10	Payroll taxes ...........	172,195,247	148,643,438	22,989,270	562,539
11	Fees for services (non-employees):
a	Management ......	4,685,001	4,059,521	625,480
b	Legal .........	9,103,278	7,887,927	1,215,351
c	Accounting ...........	2,446,292		2,446,292
d	Lobbying ...........	756,539	756,539
e	Professional fundraising services. See Part IV, line 17	1,625,085			1,625,085
f	Investment management fees ......	21,450,898		21,450,898
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	217,534,037	187,063,925	29,042,316	1,427,796
12	Advertising and promotion ....	29,446,641	25,482,673	3,931,333	32,635
13	Office expenses .......	61,151,966	52,619,500	8,164,215	368,251
14	Information technology ......	94,679,595	82,037,607	12,640,388	1,600
15	Royalties ..	2,865,559	2,482,987	382,572
16	Occupancy ...........	99,526,549	86,239,058	13,287,491
17	Travel ............	21,222,462	18,002,063	2,833,347	387,052
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	8,270,178	6,937,695	1,104,127	228,356
20	Interest ...........	96,224,727	83,378,053	12,846,674
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	264,211,514	228,907,234	35,274,085	30,195
23	Insurance ...	49,045,743	42,497,793	6,547,950
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	1,222,996,723	1,222,986,797		9,926
b	BAD DEBT EXPENSE	160,041,131	160,041,131
c	EQUIPMENT RENTAL & MAIN	84,826,690	73,468,511	11,324,957	33,222
d	STATE FRANCHISE FEE	48,475,976	48,475,976
e	All other expenses	58,248,147	54,063,452	4,121,020	63,675
25	Total functional expenses. Add lines 1 through 24e	5,883,535,837	5,258,722,543	610,507,346	14,305,948
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			245,390,860	1	481,200,626
2	Savings and temporary cash investments .........			17,465,114	2	8,741,538
3	Pledges and grants receivable, net ......			199,769,348	3	208,748,883
4	Accounts receivable, net .............			683,619,350	4	763,655,344
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				7,103,879	5	7,444,253
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
					6
7	Notes and loans receivable, net ....			110,033,731	7	21,957,604
8	Inventories for sale or use ........			88,014,066	8	97,643,634
9	Prepaid expenses and deferred charges ......			42,804,101	9	56,370,802
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	6,343,641,543
b	Less: accumulated depreciation	10b	3,516,711,937	2,643,049,067	10c	2,826,929,606
11	Investments—publicly traded securities .			2,984,766,405	11	2,515,396,435
12	Investments—other securities. See Part IV, line 11 .....			2,666,755,619	12	2,699,313,234
13	Investments—program-related. See Part IV, line 11 ..			217,756,770	13	258,142,930
14	Intangible assets ...............			60,487,897	14	62,134,669
15	Other assets. See Part IV, line 11 ...........			903,063,779	15	983,227,000
16	Total assets. Add lines 1 through 15 (must equal line 34)...			10,870,079,986	16	10,990,906,558

17	Accounts payable and accrued expenses .....	812,690,004	17	852,651,056
18	Grants payable ...	447,223	18	453,264
19	Deferred revenue .........	89,299,340	19	77,384,613
20	Tax-exempt bond liabilities .........	2,871,891,550	20	2,794,852,235
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,334,370	23	105,000,000
24	Unsecured notes and loans payable to unrelated third parties ..	174,058,227	24	123,457,997
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	1,518,213,075	25	1,607,305,940
26	Total liabilities. Add lines 17 through 25..	5,467,933,789	26	5,561,105,105

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	4,582,411,796	27	4,579,477,000
28	Temporarily restricted net assets ...........	520,252,717	28	535,481,972
29	Permanently restricted net assets	299,481,684	29	314,842,481
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	5,402,146,197	33	5,429,801,453
34	Total liabilities and net assets/fund balances ........	10,870,079,986	34	10,990,906,558

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No