Despite Cleveland Clinic’s global presence, the vast majority of the system’s operations are based in Ohio, where the system is the largest employer in the northeast part of the state and second largest in the state. Cleveland Clinic’s main campus alone employs more than 26,000 people, has revenues of nearly $4 billion, and procures more than $1.5 billion in goods and services annually. In recent years, it has adopted a variety of anchor strategies, including shifting a percentage of procurement locally and to minority-owned businesses, participating as an anchor partner in a comprehensive neighborhood revitalization effort, implementing childhood wellness programming in local school districts, and positioning itself as a leader in sustainability.