2017 Annual Report Table of Contents

MISSION Leading the way to a healthier you and a healthier community through service, teaching, discovery and teamwork. 2017 ANNUAL REPORT TABLE OF CONTENTS Message from the CEO 6 Enrollment Van 27 Finances 8 Health Care at the Juvenile Detention Center 27 Community Benefit 9 Health Care for Recovery Resources 27 Healthy Cities Cleveland 27 Statistical Highlights 10 Healthy Eating & Active Living (HEAL) 28 Employee Growth 11 HIP-Cuyahoga 28 Locations 12 Home-Based Primary Care 28 Transformation 14 Infant Mortality 28 Community Programs 20 Kidz Pride Clinic 29 Advancing Health Equity 20 MDA Care Center 29 Aamoth Family Pediatric Wellness Center 21 Medical Home for Children in Foster Care 30 Asia-International Community Health Center 21 Medication Assistance 30 Better Health Partnership 22 Mother and Child Dependency Program 30 Bringing Education, Advocacy and Support Together Nurse-Family Partnership 31 (BREAST)/AMIGAS Program 22 Oscar Hispanic Clinic 32 Care Alliance 22 Pride Clinic 32 Center for Reducing Health Disparities 22 Project DAWN 33 Community Advocacy Program (CAP) 23 SANE 33 Compass Services 23 School Health Program 34 Comprehensive Care Practice 24 Shower Clinic 34 Correctional Health Program 24 Tuberculosis Clinic 34 Cuyahoga County Health Care Council 25 Volunteer Services 35 Cuyahoga County Women, Infants, and Children (WIC) Program 25 Weight Loss Surgery and Weight Management Center 36 Cuyahoga Health Access Partnership (CHAP) 25 Window of Health 37 Doctors on the Streets (DOTS) 25 Young Adult Clinic 37 Easier Access for All 26 Zubizarreta House 37 Elisabeth’s House: The Prentiss Pediatric Crisis Nursery 26 Employee Giving 26 4 Nurturing Community Well-Being 38 Cultivating Neighborhood Prosperity 48 Adult Burn Survivor Recovery Group 39 Diversity Recruitment 49 Arts in Medicine 40 Eighth Largest Employer in Cuyahoga County 50 Build Health Grant 40 Food Service Training 50 Burn Music Therapy 41 La Villa Hispana 50 Clinics in Discount Drug Marts 41 Training for Adults with Developmental Disabilities 51 Cuyahoga County Public LIbrary at MetroHealth Medical Center 41 Transgender Job Fair 51 Farm Stand 41 Promoting Learning 52 Friends of Mothers and Infants 41 Annual Bereavement Conference 53 Healing Hearts 42 Annual Pastoral Care Conference 53 Hearts Against Hunger 42 Boot Camp for New Dads 53 Holiday Grants 42 Breastfeeding Clinic 54 Injury Prevention Initiatives 42 Childbirth Preparation Classes 54 MetroHealth Care Partners Medicare ACO 43 Community Health Advocacy Initiative 54 Mi MetroHealth at La Placita 44 Diabetes Self-Management Education Program 55 Northern Ohio Trauma System (NOTS) 44 Doula Volunteer Program 55 Ohio’s Only Ebola Treatment Center 45 Language Access and Communication Services Center 56 Open Streets Cleveland 45 Library Cards for Newborns 56 Partnership for a Healthy North Royalton 45 Lincoln-West School of Science and Health 56 Stance 46 MetroHealth Institute of Burn Ethics 56 Survivor Recovery Services 46 MetroHealth Research Institute 56 The Center for Health Affairs, Mother Nurture Project 57 Community Health Needs Assessment (CHNA) Roundtable 46 Reach Out and Read 58 The MetroHealth Foundation 47 Renee Jones Empowerment Center 58 Voter Registration 47 Safe Sleep Initiative 58 Sibling Classes 58 Simulation Center 59 Smoking Cessation 59 St. Martin De Porres Program 59 Teaching Hospital Affiliated with Case Western Reserve University School of Medicnie 59 5 MESSAGE FROM THE CEO To care for everyone — no matter how sick or how poor. The leaders of Cleveland founded City Hospital on that promise. And as we grew and became MetroHealth, we kept that promise, for 180 years. A few years ago, we made another promise to this community: We would rebuild our main campus hospital — the hospital for all people — so everyone in Cuyahoga County would have access to high-quality, affordable health care that heals and lifts them up. Plans are underway to reconstruct the West 25th Street campus. As signifi cant as this is, we know it’s not enough. We can do more. And we will. We will build a brighter future for this community, not just with bricks and steel, but with a broader — and deeper — commitment to our mission. As you’ll read in this annual report, we are improving our neighborhood, nurturing our community, promoting learning and working toward equality in health for everyone. And we plan to continue that — for another 180 years and beyond. Akram Boutros, MD President and CEO The MetroHealth System 6 “ Our standout event of the “ It’s an honor and privilege to year was selling the bonds serve as chair of The MetroHealth to fi nance the new hospital. Foundation Board of Directors We might be the only public and work with such a highly hospital to ever do that and engaged group of civic leaders. our success was fueled by our Our commitment to raising $100 fi nancial performance in the million over fi ve years will support last few years, backed by our MetroHealth’s vast efforts in consistent quality care. I look improving the health of our with optimism and excitement community. Together, we have toward our future and what it the opportunity to benefi t our will mean for our community.” region by promoting innovation, development and programming.” To see a list of donors, visit metrohealth.org/2017-donors. Thomas McDonald Brian M. O’Neill Chairman, Board of Trustees Chair, Board of Directors The MetroHealth System The MetroHealth Foundation Chief Executive Offi cer & President Partner McDonald Partners, LLC Tucker Ellis, LLP 7 2017 ANNUAL REPORT FINANCES BUILDING ON OUR STRENGTHS OPERATING REVENUE 2012 $783 M 2013 $855 M 44.5% 2014 $905 M INCREASE IN 2015 $934 M 5 YEARS 2016 $1.04 Billion 2017 $1.13 Billion EARNINGS* $32.4 M $96.1 M 2.9% OPERATING INCOME** CUYAHOGA COUNTY OF TOTAL OPERATING SUBSIDY (TAXPAYER SUPPORT) REVENUE $41.5 M * Earnings before interest, depreciation and amortization, which excludes non-cash actuarial pension adjustment (GASB 68) ** Operating income, which excludes non-cash actuarial pension adjustment (GASB 68) 8 COMMUNITY BENEFIT SUBSIDIZING CARE FOR THOSE WHO NEED IT MOST Investing in Cuyahoga County through programs to increase access to health care services and improve community health. $231 Includes uncompensated care, financial assistance, 100+ community programs, MILLION education and research. IN COMMUNITY BENEFIT Descriptions begin on page 20. PORTION OF OPERATING EXPENSES THAT GOES BACK TO OUR COMMUNITY THE METROHEALTH SYSTEM* (2.2X NATIONAL AVERAGE) 21.3% U.S. HOSPITALS AVERAGE** 9.7% *MetroHealth community benefit calculation for the year ended 2017 **From Ernst & Young 2016 Schedule H Benchmark Report for the American Hospital Association 9 2017 ANNUAL REPORT STATISTICAL HIGHLIGHTS ADDING PATIENT VISITS EVERY YEAR Total Patient Visits 1,405,542 Inpatient 25,399 Outpatient 1,239,970 Emergency Department* 140,173 39% Babies Delivered 3,117 INCREASE IN Metro Life Flight Transports 3,500 5 YE ARS Helicopter 1,532 Ground 1,968 Major Trauma Cases 4,827 In the last two years, with an emphasis on preventive care, outpatient visits increased by 18% and hospital patient days decreased by 3.8%. This points toward better long- term health and lower health care costs for everyone. * at our West 25th Street verified Level I Trauma and Burn Center, and our three emergency departments in Brecksville, Cleveland Heights and Parma 10 EMPLOYEE GROWTH EXPANDING OUR TALENTED TEAM 2012 6,155 21% 2013 6,387 INCREASE IN 2014 6,617 5 YEARS 2015 6,759 2016 7,376 2017 7,467 Distribution as of December 31, 2017 Inclusion and Diversity Nurses 2,018 As an organization, we are committed to reflecting the Physicians* 626 diverse patient population and Residents 390 community we serve. All other employees 4,433 Total 7,467 In 2017, of the 80% of hires who self-identified, 37% were racially/ethnically diverse. * All MetroHealth active staff physicians are faculty of Case Western Reserve University School of Medicine. 11 2017 ANNUAL REPORT LOCATIONS PROVIDING CARE WITH CONVENIENCE To better serve residents in eastern and western Cuyahoga County, we planned for the January 2018 opening of new hospitals at our Cleveland Heights and Parma buildings, which already had Emergency Departments, primary care and specialty care. METROHEALTH LOCATIONS AS OF JANUARY 2018: Health Centers • Beachwood Health Center • MetroHealth Medical Center Parma • Bedford Medical Offi ces • Parma Health Center 22 • Brecksville Health and Surgery Center • Physical Therapy at West Shore Family YMCA • Broadway Health Center • Rocky River Medical Offi ces • Brooklyn Health Center • State Road Family Practice • Brunswick Health Center • Thomas F. McCafferty Health • Buckeye Health Center Center* • MetroHealth Medical Center • West 150th Health and Surgery Cleveland Heights Center • J. Glen Smith Health Center* • West Park Health Center • Lyndhurst Health Center • Westlake Health Center • MetroHealth Medical Center Main Campus *Operating in partnership w/ city of Cleveland • Middleburg Heights November Family Health Center • MetroHealth Medical Center Old Brooklyn 12 Emergency MetroExpressCare Departments • Beachwood • Broadway • Brecksville • Middleburg Heights 4 • Cleveland Heights 5 • West Park • Main Campus (Cleveland) • Westlake • Parma Pharmacies Schools Served by • Bedford In-School Clinic or • Brecksville Mobile Van • Broadway (Cleveland) 13 9 Elementary and Middle Schools • Buckeye (Cleveland) • Anton Grdina School • Cleveland Heights • Buhrer Dual Language Academy • Main Campus (Cleveland) • Fullerton School of Academics

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