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      <Form990PartVIISectionAGrp>
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        <PersonNm>JANIE PARRINO</PersonNm>
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      <OtherExpensesGrp>
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      <OtherExpensesGrp>
        <Desc>DUES AND SUBSCRIPTION</Desc>
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        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
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        <EmployeeCnt>0</EmployeeCnt>
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      <AccountActivitiesOutsideUSGrp>
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      <AccountActivitiesOutsideUSGrp>
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        <EmployeeCnt>0</EmployeeCnt>
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      <AccountActivitiesOutsideUSGrp>
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        <EmployeeCnt>0</EmployeeCnt>
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      <AccountActivitiesOutsideUSGrp>
        <RegionTxt>SOUTH AMERICA</RegionTxt>
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        <EmployeeCnt>0</EmployeeCnt>
        <TypeOfActivitiesConductedTxt>PROGRAM SERVICES</TypeOfActivitiesConductedTxt>
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      <AccountActivitiesOutsideUSGrp>
        <RegionTxt>MIDDLE EAST AND NORTH AFRICA</RegionTxt>
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        <EmployeeCnt>0</EmployeeCnt>
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      <SubtotalEmployeesCnt>0</SubtotalEmployeesCnt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III ACCOUNTING METHOD:</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE F, PART VI, LINE 1:</FormAndLineReferenceDesc>
        <ExplanationTxt>THERE WERE TRANSFERS OF CASH TO FOREIGN CORPORATIONS BUT THEY WERE NOT OF THE TYPE DESCRIBED IN SECTION 6038B(A)(1)(A), 367(D), OR 367(E) SO NO FORM 926 WAS REQUIRED TO BE FILED.</ExplanationTxt>
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        <TotalCompensationFilingOrgAmt>97106</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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        <FormAndLineReferenceDesc>PART I, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE TRAVEL POLICY, APPLICABLE TO ALL EMPLOYEES, ALLOWS FOR FIRST-CLASS AIR TRAVEL ON DOMESTIC RED-EYE FLIGHTS DEPARTING AFTER 9:00 PM THAT EXCEED FIVE HOURS IN DURATION. RELOCATION PACKAGES ARE GENERALLY PROVIDED TO NEW EMPLOYEES WHO RESIDE MORE THAN 50 MILES OUTSIDE OF CAMBRIDGE, MASSACHUSSETTS. THE ORGANIZATION GROSSES UP TAXABLE RELOCATION BENEFITS AND NOMINAL SPOT AWARDS FOR EXEMPLARY PERFORMANCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL EMPLOYEES ARE ELIGIBLE TO RECEIVE HIGH IMPACT BONUSES, ANNUALLY. THESE BONUSES ARE DISCRETIONARY TO BE PAID BASED ON PREDETERMINED FIXED AMOUNTS (BETWEEN $2,500 AND $10,000) AND THE TOTAL AMOUNT PAID IS DETERMINED BASED ON PERFORMANCE AND THE IMPACT ON THE ORGANIZATION. DURING 2022, GATES MEDICAL RESEARCH INSTITUTE PAID OUT HIGH IMPACT BONUSES, INCLUDING TO INDIVIDUALS LISTED ON PART VII, SECTION A.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VII, SECTION A, LINE 1:</FormAndLineReferenceDesc>
        <ExplanationTxt>TOTAL ANNUAL COMPENSATION IS REPORTED FOR ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES REGARDLESS OF THE LENGTH OF TIME ACTIVELY SERVING AS A DIRECTOR, OFFICER, OR KEY EMPLOYEE OF GATES MEDICAL RESEARCH INSTITUTE DURING 2022.</ExplanationTxt>
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    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>CAROLYN AINSLIE, TREVOR MUNDEL, TONI HOOVER, AND HELENE MADONICK HAVE A BUSINESS RELATIONSHIP AS CURRENT OR FORMER EMPLOYEES OF THE BILL &amp; MELINDA GATES FOUNDATION WHO RECEIVED COMPENSATION DURING THE YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>GATES MEDICAL RESEARCH INSTITUTE ADOPTED AMENDED AND RESTATED BYLAWS IN 2022. SIGNIFICANT CHANGES INCLUDE THE FOLLOWING: - CONFORM WITH THE NEW WASHINGTON STATE NONPROFIT CORPORATION ACT, - AMEND THE TERMS OF ARTICLE 7 REGARDING INDEMNIFICATION OF DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS, AND - ADD ARTICLE 8 REGARDING BOARD ACTION IN AN EMERGENCY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SOLE MEMBER OF BILL &amp; MELINDA GATES MEDICAL RESEARCH INSTITUTE IS BILL &amp; MELINDA GATES FOUNDATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>BILL &amp; MELINDA GATES FOUNDATION, THE SOLE MEMBER OF BILL &amp; MELINDA GATES MEDICAL RESEARCH INSTITUTE, HAS THE AUTHORITY TO APPOINT AND REMOVE DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>BILL &amp; MELINDA GATES FOUNDATION, THE SOLE MEMBER OF BILL &amp; MELINDA GATES MEDICAL RESEARCH INSTITUTE, HAS THE AUTHORITY TO AMEND THE ARTICLES OF INCORPORATION, ADOPT A PLAN OF MERGER OR CONSOLIDATION, AUTHORIZE THE SALE, LEASE, OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION, AUTHORIZE THE VOLUNTARY DISSOLUTION OF THE ORGANIZATION AND ADOPTION OF A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE ORGANIZATION, IN ACCORDANCE WITH THE ORGANIZATION'S ORGANIZATIONAL DOCUMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS PREPARED BY A THIRD-PARTY ACCOUNTANT. AFTER PREPARATION, IT IS REVIEWED IN DETAIL BY THE TREASURER OF THE INSTITUTE, AND THE TAX TEAM AND CONTROLLER OF BILL &amp; MELINDA GATES FOUNDATION, THE SOLE MEMBER OF BILL &amp; MELINDA GATES MEDICAL RESEARCH INSTITUTE. A COPY OF THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE CONSIDERED "COVERED PERSONS" FOR THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, AND AS SUCH, ARE REQUIRED TO DISCLOSE ANY RELATIONSHIPS THAT COULD GIVE RISE TO CONFLICTS OF INTEREST INVOLVING THE ORGANIZATION. IN ADDITION, ANY TRANSACTIONS BETWEEN THE ORGANIZATION AND ANY OF THESE INDIVIDUALS (OR THEIR FAMILY MEMBERS OR AN AFFILIATED ENTITY) MUST BE DISCLOSED TO THE SECRETARY. IF THE SECRETARY HAS A POTENTIAL CONFLICT OF INTEREST, IT MUST BE DISCLOSED TO THE CHIEF EXECUTIVE OFFICER. THE SECRETARY AND CHIEF EXECUTIVE OFFICER ARE RESPONSIBLE FOR REVIEWING THE ANNUAL CONFLICT OF INTEREST DISCLOSURES AND RESOLVING ANY POTENTIAL CONFLICT OF INTERESTS THAT MAY ARISE. THE COVERED PERSON IS REQUIRED TO REFRAIN FROM USING THEIR PERSONAL INFLUENCE TO ENCOURAGE THE ORGANIZATION TO ENTER INTO THE COVERED TRANSACTION. ADDITIONALLY, THEY MUST NOT PARTICIPATE IN ANY DISCUSSIONS REGARDING THE COVERED TRANSACTIONS WITH OFFICERS, DIRECTORS AND EMPLOYEES OF THE ORGANIZATION, EXCEPT TO RESPOND TO REQUESTS FOR INFORMATION. IF THE TRANSACTION IS DEEMED TO BE REASONABLE BY THE DISINTERESTED DIRECTORS (IN THE CASE OF A CONFLICT INVOLVING A DIRECTOR OR THE CHIEF EXECUTIVE OFFICER) OR CHIEF EXECUTIVE OFFICER (IN THE CASE OF A CONFLICT INVOLVING ANOTHER OFFICER OR KEY EMPLOYEE), THE ORGANIZATION MAY ENTER INTO THE TRANSACTION, AS LONG AS IT IS FAIR AND REASONABLE TO THE ORGANIZATION. SIMILAR TO THE COVERED PERSONS, ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST CERTIFICATION UPON COMMENCING EMPLOYMENT AND TO UPDATE THE CERTIFICATION ANNUALLY, AND AT ANY TIME THERE IS A CHANGE THAT REQUIRES DISCLOSURE. THE HEAD OF COMPLIANCE &amp; RISK MANAGEMENT IS RESPONSIBLE FOR REVIEWING THE CERTIFICATIONS AND ADMINISTERING AND MAINTAINING THE POLICY. THE POLICY RETAINS THAT IF AN OFFICER, DIRECTOR, OR MEMBER OF SENIOR LEADERSHIP BECOMES AWARE OF A TRANSACTION THAT COULD CAUSE A CONFLICT OF INTEREST, THEY ARE TO IMMEDIATELY DISCLOSE SUCH TO THE SECRETARY OF THE ORGANIZATION. PROCEDURES FOR RESOLVING A COVERED TRANSACTION AFTER DISCLOSURE TO THE SECRETARY REMAIN IN PLACE AS OUTLINED ABOVE.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD OF THE BILL &amp; MELINDA GATES MEDICAL RESEARCH INSTITUTE USES AN INDEPENDENT REVIEW, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION TO ESTABLISH TOTAL REMUNERATION PACKAGES FOR THE CEO, OFFICERS, AND CERTAIN KEY EMPLOYEES. THE BOARD IS PRESENTED WITH STUDY DATA, REVIEWS IT TO DETERMINE REASONABLENESS, AND THEN APPROVES TOTAL REMUNERATION ACCORDINGLY. ALL SUCH OFFICER AND CERTAIN KEY EMPLOYEE TOTAL REMUNERATION PACKAGES ARE REVIEWED AND APPROVED BY THE BOARD ANNUALLY. THE MOST RECENT COMPENSATION STUDY FOR PURPOSES OF THIS COMPENSATION PERIOD WAS CONDUCTED BY AN INDEPENDENT CONSULTANT IN 2022. COMPARABILITY DATA IS ALSO USED TO ESTABLISH COMPENSATION PACKAGES FOR OTHER EMPLOYEES. COMPENSATION PACKAGES FOR OTHER EMPLOYEES ARE APPROVED BY THE CEO ANNUALLY, BASED ON A COMPENSATION PHILOSOPHY ORIGINALLY APPROVED BY THE BOARD.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. BILL &amp; MELINDA GATES MEDICAL RESEARCH INSTITUTE'S FINANCIAL STATEMENTS ARE CONSOLIDATED WITH BILL &amp; MELINDA GATES FOUNDATION, AND THE CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE AT WWW.GATESFOUNDATION.ORG.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>ANY OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE THAT IS OR WAS AN EMPLOYEE OF THE BILL &amp; FOUNDATION CAN BE REACHED AT THE FOLLOWING ADDRESS. FOR 2022, THIS INCLUDES SUSAN DESMOND-HELLMANN, CAROLYN AINSILE, TREVOR MUNDEL, HELENE MADONICK, AND TONI HOOVER: P.O. BOX 23350 SEATTLE, WA 98102</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 17,708,332. MANAGEMENT AND GENERAL EXPENSES 910,710. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,619,042. SCIENTIFIC CONSULTING AND TECHNICAL ASSISTANCE: PROGRAM SERVICE EXPENSES 53,243,592. MANAGEMENT AND GENERAL EXPENSES 67,601. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,311,193. OPERATIONAL ASSISTANCE: PROGRAM SERVICE EXPENSES 35,000. MANAGEMENT AND GENERAL EXPENSES 2,982,382. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,017,382.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>CONTRIBUTION ADJUSTMENT -15,000.</ExplanationTxt>
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