HEALTH CARE INDUSTRY in NORTHEAST OHIO 37% 21% 270,000+ GROWTH in Workers 2 019 GDP in HEALTH CARE Growth OCCUPATIONS 2001-2 019 2001-2 019

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THE $22 BILLION HEALTH CARE INDUSTRY IN NORTHEAST OHIO 37% 21% 270,000+ GROWTH IN workers 2 019 GDP IN HEALTH CARE growth OCCUPATIONS 2001-2 019 2001-2 019

Momentum Is Strong in the NEO Health Care Industry Northeast Ohio is a health care hub with more than 60 hospitals, including the world-renowned Cleveland Clinic, Akron General, University Hospitals, and University Hospitals Rainbow Babies & Children’s Hospital, Aultman Hospital, Mercy Medical Center, Northeast Ohio Medical University (NEOMED) and many other Northeast Ohio health care-related institutions. Quarterly Economic Review DECEMBER 2019 In addition, the region's health care industry is supported with a vibrant biomedical community that includes 700 biomed Quarterly Economic Indicators businesses, which have raised more than $3 billion in growth 18 Counties of Northeast Ohio capital since 2002. As reported earlier this year in the Aligning Opportunities in Northeast Ohio report, prepared by Team NEO in partnership with Delta Dental and with the generous support of Sherwin-Williams, health care is one of Northeast Ohio’s strongest industries.

The region’s health care workforce, which includes individuals with diverse levels of education, has grown significantly over the past couple of decades and is expected to continue growing.

Health care GDP has increased as well — by 37% since 2001. Now a $22 billion industry, health care stands strong as a major driving force in Northeast Ohio’s economy.

Change in Northeast Ohio Health Care GDP: 2001 - 2019

$22

$21

$20

$19

$18 BILLIONS $17

$16

$15

$14

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

THE STEADY RISE OF HEALTH CARE GDP Health care GDP grew 37% from 2001 to 2019, reflecting growth from $16 billion to $22 billion overall. Ambulatory health care services and hospitals account for the lion’s share of GDP, with ambulatory services contributing 46% and hospitals 42% of the total. Nursing and residential care facilities contribute the remaining 12%. Growth in Northeast Ohio Health Care Employment: 2001 - 2019

+25%

+20%

+15%

+10% Ambulatory Health + 5% Care Services

1.00 - 5% +25% -10%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

1.0 = 2001 average

Components of Northeast Ohio Health Care Employment Growth: 2001 - 2019

120,000

110,000 Hospitals 100,000

90,000

80,000 +21%

70,000

60,000

50,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Ambulatory Health Hospitals Nursing & Residential Care Services Care Facilities

EMPLOYMENT GROWS 21% Nursing & Residential Care Facilities Since 2001, health care employment has grown steadily, to 270,400 workers. This 21% overall increase reflects employment growth in the following sectors: ambulatory health care services, up 25%; hospitals, up 21%; and nursing and residential care facilities, up 17%. +17 % Industry Sectors with the Largest Share of Minority Employment: 2019 MINORITY REPRESENTATION IN HEALTH CARE Retail Trade Health care is one of the top Real Estate & Rental & Leasing three industries in Northeast Ohio Headquarters for minority employment, with Arts, Entertainment & Recreation nearly a quarter of health care

Government occupations currently filled Transportation by people of color. Only adminis- & Warehousing trative/support and agriculture/ Health Care forestry/fishing/hunting employ Accommodation & Food Services a larger percentage. Agriculture, Forestry, Fishing & Hunting

Administrative & Support

0 5% 10% 15% 20% 25% 30% 35%

BIOMEDICAL SECTOR FLOURISHES In addition to strength on the clinical side of this vital industry, Northeast Ohio’s biomedical sector – including medical devices, pharmaceuticals and therapeutics, health IT software and services, and research and development — continues to thrive. Innovation in the bioscience sector fuels new company creation, growth and employment.

Cleveland alone boasts more than 700 biomed businesses, which have raised more than $3 billion in growth capital since 2002. According to BioEnterprise’s 2018 Midwest Healthcare Growth Capital Report, 71 Northeast Ohio biomedical companies raised $294 million in growth capital in 2018 alone, making NEO the third-largest region in total investments in the Midwest. In total, 438 Midwest biomedical companies raised $2.5 billion in capital in 2018. That amount validates a record increase of 43% in 2017, showing continued momentum in this important health care sector. Total Entry-Level Median Family- TOP 10 Risk of Demand Demand Hourly Sustaining Automation Occupations 2018 2018 Earnings Wage

Registered Nurses 9,950 7,077 $31.54 Above Low

Nursing Assistants 2,612 622 $12.39 Below Low

Home Health Aides 2,335 700 $10.03 Below Low

Licensed Practical and 1,791 899 $20.46 Below Low Licensed Vocational Nurses

Clinical Laboratory Technologists 1,031 423 $26.48 Above Low and Technicians

Physicians and Surgeons 1,012 51 $102.27 Above Low

Pharmacy Technicians 1,008 321 $14.19 Below High

Nurse Practitioners 841 482 $47.61 Above Low

Medical Records and Health 738 416 $17.51 Below High Information Technicians

Physical Therapists 727 326 $41.31 Above Low

EMPLOYMENT OPPORTUNITIES ABOUND The Aligning Opportunities report revealed an abundance of available job opportunities in the Northeast Ohio health care sector, from entry-level positions to high-level, specialized occupations. The greatest opportunity exists for candidates who have earned appropriate credentials — i.e., an academic degree or a professional certification.

Recognizing that cultivating a robust talent pipeline will help ensure the sustained growth of this important industry, the region’s corporate and civic leaders, educators and economic development organizations are focusing efforts on connecting candidates with outstanding career education and training opportunities to prepare them for these careers. 1 2

Link 59 The Innovation Center

Address: 6100 Euclid Ave, Date Available: Address: 703 S Cleveland- Date Available: Cleveland, Cuyahoga Immediately Massillon Rd., Fairlawn, Summit Immediately

Available SF: 20,554 Type: Office Available SF: 14,429 Type: Class A

Description: Situated along Cleveland’s Health Tech Corridor, Description: This Class A property, built in late 2008, includes Link59 is a state-of-the-art, newly constructed, 61,000 square 97,845 sq.ft. and features four stories and cutting-edge materials, foot building with office and R&D space with free parking complete with a forward-thinking office environment and a available on site. planned state-of-the-art innovation center. The suites come fully furnished with private offices, conference rooms, cubicles, break and training rooms.

3 4

Research Laboratory Property In Valley View Former TRW World Headquarters

Address: 7650 Hub Parkway, Date Available: Address: 1950 Richmond Road, Date Available: Valley View, Cuyahoga Immediately Lyndhurst, Cuyahoga Immediately

Available SF: 12,500 Type: Research Lab Available SF: 476,030 Type: Class A

Description: This is a 12,500 sq. ft. Research Lab with Wet-Lab Description: Maintained by the Cleveland Clinic, this office capability, formerly occupied by Sherwin-Williams R&D group. space is the former world headquarters of TRW. Built in 1985, This building boasts many first-class amenities including hoods, the facility offers over 400,000 sf of quality office space with over vents, engineered air make-up system, compressed air, completely 500 underground parking spots. It sits on nearly 100 acres and air conditioned, Di water, and much more. The building sites comes with The Bolton Manor, a mansion that may be used on 2 additional acres that can be used for expansion. how the owner sees best fit. This property has quick access to I-271 and an abundance of local food and retail. DEVELOPMENT ACTIVITY

Over the past five years, Northeast Ohio has seen 50 health care-related company expansions. Below is a sampling of development projects across the region in this industry.

THE SMITHERS GROUP MAKES AKRON STERIS CORPORATION DEMONSTRATES COMMITMENT ITS WORLD HEADQUARTERS TO NORTHEAST OHIO

The former home of a nonprofit medical research and STERIS Corporation, a leading provider of infection-prevention development center, Austen BioInnovation Institute in Akron and other products and services for the pharmaceutical, (ABIA) will become the new world headquarters of The medical device, personal care product and cosmetic Smithers Group. This $22 million project will involve total industries, continues to grow at its Mentor campus. Recently renovation of the six-story downtown Akron office building the company expanded its administration building with a and the construction of additional office, R&D, lab and 30,000-square-foot addition to accommodate customer parking space to the complex. The Smithers Group, a service growth. The expansion resulted in the addition of multinational provider of testing, consulting, information, 150 new hires to the organization’s 1,576-employee base and compliance services that employs 800 workers at the Mentor campus. worldwide, will create 84 jobs while retaining 145 positions. RELINK MEDICAL MOVES HEADQUARTERS TO TWINSBURG OPTION CARE BUILDS EMPLOYEE WORKFORCE ReLink Medical, a unique health IT company that streamlines Option Care Enterprises Inc., the nation’s largest the process of hospitals to dispose of obsolete, excess or independent provider of home and alternate-site infusion out-of-service medical equipment, has moved its headquarters services, has committed to growing its business in Northeast to Twinsburg. The company plans to add 30 new positions, Ohio by adding to its current workforce of 148. The company doubling its current workforce. provides patients with multidisciplinary care from diagnosis through completion, or long-term maintenance therapy.

Health Care Expansions 2014 - 2019

Abeona Therapeutics Inc. Innovative Medical Equipment LLC Sotera Health LLC Alltech Medical Systems Inogen, Inc. Steris Corporation America, Inc. Keyghobad Ventures, LLC DBA The Schroer Group, Inc. Applied Medical Technology, Inc. NanoBioSystems The ScottCare Corporation Arteriocyte, Inc. MedInvent, LLC Theken Companies, LLC Brooks Life Sciences Nervine, Inc Wellness IQ, Inc. Cardioinsight Technologies Inc. Option Care Enterprises, Inc. Xellia Pharmaceuticals USA LLC City of Cleveland Piping Rock Health Products, LLC Zimmer Surgical, Inc. Complion Inc. Population Genetics Zuga Medical Discount Drug Mart, Inc. Technologies Ltd. Echo Health, Inc. Quadax, Inc. Exact Care Pharmacy, LLC Quality Electrodynamics LLC Exsurco Medical, Inc. Relatecare, LLC GenomOncology, LLC RhinoSystems, Inc. GOJO Industries, Inc. ROE Dental Laboratory, Inc. Infinite Arthroscopy, Inc. Smithers RAPRA NORTHEAST OHIO TOTAL EMPLOYMENT (NOT SEASONALLY ADJUSTED)

2.05 TOTAL EMPLOYMENT GROWS 2.00 YEAR-OVER-YEAR 1.95 Total employment averaged 1.91 million 1.90 workers in Q1 2019, up more than 15,300

1.85 jobs year-over-year.

1.80 Source: Quarterly Census of Employment and Wages (QCEW). This is the most 1.75 TOTAL EMPLOYMENT IN MILLIONS EMPLOYMENT TOTAL current reliable data available for total 1.70 jobs in Northeast Ohio.

1.65 2011 2012 2013 2014 2015 2016 2017 2018 2011 2012 2013 2014 2015 2016 2017 2018 2011 2012 2013 2014 2015 2016 2017 2018 2011 2012 2013 2014 2015 2016 2017 2018 2010 2010 2010 2010 2019 2008 2008 2008 2008 2007 2007 2007 2007 2009 2009 2009 2009 Q1 Q2 Q3 Q4

NORTHEAST OHIO UNEMPLOYMENT RATES THROUGH MARCH 2019

12 %

11% OHIO 10 % NEO YEAR-OVER-YEAR UNEMPLOYMENT RATE 9% US The unemployment rate for Northeast Ohio

8% averaged 5.1% in Q1 2019. This represents a .3% improvement in the unemployment

7% rate as compared with Q1 2018, when it NEO was 5.4%. The state of Ohio averaged

6% 4.7%, while the U.S. averaged 4.1%, in Q1 2019. 5% Source: Current Population Survey (CPS), a survey of 60,000 households nationwide. 4%

3% Q1 11 Q2 11 Q3 11 Q4 11 Q 1 14 Q 2 14 Q1 12 Q 1 13 Q 2 13 Q 3 13 Q 4 13 Q 3 14 Q 4 14 Q 1 15 Q 2 15 Q 3 15 Q 4 15 Q 1 16 Q 2 16 Q 3 16 Q 4 16 Q 1 17 Q 2 17 Q 3 17 Q 4 17 Q 1 18 Q 2 18 Q 3 18 Q 3 18 Q 4 18 Q 1 19 Q1 10 Q 3 12 Q3 10 Q2 10 Q4 10 Q 2 12 Q 4 12 Q1 08 Q1 Q1 09 Q1 Q4 09 Q1 07 Q2 07 Q3 07 Q4 07 Q2 08 Q3 08 Q4 08 Q2 09 Q3 09

NEO OHIO US

CHANGE IN EMPLOYMENT BY SECTOR THROUGH MARCH 2019

+20% ALL SECTORS SEE YEAR-OVER-YEAR

+10% GROWTH SERVICES In Q1 2019, the construction sector add- 1.00 ed more than 3,300 jobs year-over-year, with about 69,000 total workers. At almost -10% 270,000 jobs, the manufacturing sector added just over 3,000 jobs year-over-year, -20% while the services sector added nearly 7,800 workers year-over-year. -30% Source: Quarterly Census of Employment MANUFACTURING and Wages (QCEW). This is the most current -40% reliable data available for total jobs CONSTRUCTION in Northeast Ohio. -50% Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q 3 13 Q 4 13 Q1 10 Q 1 13 Q 2 13 Q2 10 Q3 10 Q4 10 Q 2 12 Q 3 12 Q 4 12 Q1 14 Q2 14 Q3 14 Q4 14 Q1 08 Q1 Q1 09 Q1 Q1 07 Q2 07 Q3 07 Q4 07 Q2 08 Q3 08 Q4 08 Q2 09 Q3 09 Q4 09 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16 Q4 16 Q1 17 Q2 17 Q3 17 Q4 17 Q1 18 Q2 18 Q3 18 Q4 18 Q1 19

MANUFACTURING CONSTRUCTION SERVICES

1.00 = 2007 AVERAGE NEO REAL GROSS REGIONAL PRODUCT (GRP) IN BILLIONS

$250 2.3% GRP PROJECTED TO REACH % % 0.2% 1.3% % 2.8 0.4 0.6% 1.4% 0.7 $238.5 BILLION $230 3.3% 2.4% -0.8% -1.5% 2.1% -0.4% Moody’s Economy.com is projecting % 1.3 % % 4.0% 1. 6 -2.0% 1.4 3.0% $210 -5.3% Northeast Ohio’s GRP to grow 2.3% in 4.4% 3.0% 2018 to reach $238.5 billion. Projections

$190 3.3% are continuously updated and subject to change for up to 18 months. $170 Source: Moody’s Economy.com NEO REAL GRP IN BILLIONS $150

$130 2 011 2010 2 012 2 013 2 014 2 015 2 016 2 017 2 018 1994 1995 1996 1997 1998 1999 2001 2000 2002 2003 2004 2005 2006 2007 2008 2009

REAL GRP AVERAGE ANNUAL GROWTH = 1%

NORTHEAST OHIO INDUSTRIAL AND OFFICE VACANCY

10 % INDUSTRIAL AND OFFICE VACANCY RATES TRACKING LOW 9% In Q1 2019, the vacancy rate for industrial space is at 3.5%, while the vacancy rate 8% for office space is at 7.0%.

7% Source: CoStar

6% VACANCY RATE VACANCY

3% Q1 11 Q1 10 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 13 Q3 13 Q4 13 Q1 14 Q2 14 Q3 14 Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 10 Q3 10 Q4 10 Q1 08 Q1 Q2 16 Q3 16 Q4 16 Q1 17 Q2 17 Q3 17 Q4 17 Q1 18 Q2 18 Q3 18 Q4 18 Q1 19 Q1 09 Q1 Q2 08 Q3 08 Q4 08 Q2 09 Q3 09 Q4 09

OFFICE INDUSTRIAL

OHIO UTICA WELL ACTIVITY (NONCUMULATIVE)

250 1200 OHIO UTICA WELL ACTIVITY ) (NONCUMULATIVE) 1000 200 ) This graph shows the status of Utica shale wells originally permitted, 800 drilled and in production for each

NON-CUMULATIVE 150 ( CUMULATIVE quarter. Since tracking results in Q4 2012, ( 600 2,955 total permits have been issued, of which 2,011 have been drilled. Of 100 the 2,011 drilled, 1,037 are currently in 400 production in the state.

50 Source: Ohio Department of PRODUCING WELLS 200 Natural Resources PERMITTED/DRILLED WELLS

0 0 Q417 Q219 Q119 Q2 17 Q3 17 Q1 18 Q2 18 Q3 18 Q4 18 Q1 16 Q2 16 Q3 16 Q4 16 Q1 17 Q 4 12 Q 1 13 Q 2 13 Q 3 13 Q 4 13 Q 1 14 Q 2 14 Q 3 14 Q 4 14 15 Q1 15 Q2 15 Q3 15 Q4

PERMITTED DRILLED PRODUCING WELLS SPECIAL THANKS FROM TEAM NEO TO OUR INVESTORS

For a complete list of funders, visit teamneo.org/investors.

DATA SOURCES ECONOMIC DEVELOPMENT PARTNERS ACROSS 18 COUNTIES OF NORTHEAST OHIO

Team Northeast Ohio uses a number of data sources for the Ashland Area Economic Development Regional Economic Review. One of the primary sources is Columbiana County Port Authority Moody’s Economy.com (economy.com) data for Northeast Ohio. Erie County Economic Development Corporation Moody’s Economy.com county-level output, employment and payroll Geauga Growth Partnership, Inc. historical data are estimated from several publicly available sources and Greater Akron Chamber are summarized into the Team NEO regional footprint. It is important Greater Cleveland Partnership to understand data provided by Economy.com are estimates of economic activity. Growth Partnership for Ashtabula County Huron County Development Council Team NEO also uses data from federal and state sources as part of this report. We rely heavily on data from the U.S. Bureau of Labor Lake County Ohio Port & Economic Development Authority Statistics (bls.gov) and Ohio’s Labor Market Information (lmi.state.oh.us) Medina County Economic Development Corporation for information on wages, unemployment and both general and Portage Development Board industry-specific employment. Richland Community Development Group Industrial and office real estate data for this edition were derived Stark Economic Development Board, Inc. from the CoStar Group. Due to market limits within the CoStar database, Tuscarawas County Economic Development Corporation historic trend data for the Team NEO region are reflective of 14 of the 18 counties forming the regional footprint. These counties include: Youngstown/Warren Regional Chamber Ashtabula, Cuyahoga, Erie, Geauga, Huron, Lake, Lorain, Mahoning, Wayne Economic Development Council Medina, Portage, Richland, Stark, Summit and Trumbull.

ABOUT TEAM NEO CONNECT WITH US teamneo.org

Team NEO is a private, nonprofit economic development organization accelerating business growth and job creation throughout the 18 counties of Northeast Ohio. As the designated JobsOhio Network Partner, we align and amplify local economic development efforts in Northeast Ohio’s 18-county region; we conduct research and data analysis to inform local conversations and influence solutions; we market Northeast Ohio as a region; and we work to increase access to jobs, education and training for the region’s 4.3 million people. For more information, visit teamneo.org.