2019-11-12T02:51:23-06:00 2018-12-31 861065772 DELOITTE TAX LLP 655 WEST BROADWAY SUITE 700 SAN DIEGO CA 921018590 990 2018-01-01 264146730 GARY AND MARY WEST HEALTH INSTITUTE GARY 8585357000 10350 NORTH TORREY PINES ROAD LA JOLLA CA 92037 SHELLEY LYFORD PRESIDENT AND CEO 8585357000 2019-10-07 1 DIANA J MCCUTCHEN P00545657 6192326500 167.219.0.219 2019-10-07 12:22:33 PD P CD71869BFC494223FABD92E93AB0669CE7B22062 76FF2A6BB2396675DA7FC3BECCB7F23E28595D91 2018 2020-03-31 21:24:44Z SHELLEY LYFORD 10350 NORTH TORREY PINES ROAD LA JOLLA CA 92037 25825087 0 X WWW.WESTHEALTH.ORG X 2009 DE CONDUCTING MEDICAL RESEARCH WITH HOSPITALS TO REDUCE HEALTHCARE COSTS WITH A FOCUS ON SENIORS. 5 3 29 5 0 31032 15750000 25750000 0 0 -4553446 87 85115 75000 11281669 25825087 19133 47392 0 0 4463400 4843533 0 0 0 18018155 21963511 22500688 26854436 -11219019 -1029349 12439679 12461358 5408254 6459282 7031425 6002076 X MEDICAL RESEARCH TO LOWER THE COST OF HEALTHCARE AND ENABLE SENIORS TO SUCCESSFULLY AGE, LIVING LIFE ON THEIR OWN TERMS WITH ACCESS TO HIGH-QUALITY HEALTH AND SUPPORT SERVICES THAT PRESERVE AND PROTECT THEIR DIGNITY, QUALITY OF LIFE AND INDEPENDENCE. 0 0 19718125 47392 IN 2018, THE GARY AND MARY WEST HEALTH INSTITUTE (INSTITUTE) ACTIVELY CONDUCTED APPLIED MEDICAL RESEARCH, IN CONJUNCTION WITH THE HOSPITALS LISTED ON SCHEDULE A, TO GENERATE THE EVIDENCE NEEDED FOR HEALTHCARE PROVIDERS, POLICYMAKERS AND COMMUNITIES TO ADOPT MODELS OF CARE THAT BETTER SERVE SENIORS AND THEIR FAMILIES. THE GOAL IS TO LOWER THE COST OF HEALTHCARE AND ENABLE SENIORS TO SUCCESSFULLY AGE IN PLACE WITH ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH AND SUPPORT SERVICES THAT PRESERVE AND PROTECT THEIR DIGNITY, QUALITY OF LIFE AND INDEPENDENCE.WITH MORE THAN 10,000 U.S. BABY BOOMERS TURNING 65 EVERY DAY, SENIORS ARE ONE OF THE LARGEST POPULATIONS IMPACTING THE HEALTHCARE SYSTEM. THE INSTITUTE IS EXPLORING OPPORTUNITIES THAT WILL LOWER THE COST OF HEALTHCARE, IMPROVE ACUTE CARE FOR SENIORS IN THE EMERGENCY DEPARTMENT, HOME AND COMMUNITY; CHRONIC CARE MANAGEMENT FOR OLDER ADULTS THAT MAY NEED HELP AT HOME; AND SUPPORTIVE SERVICES SO SENIORS CAN RECEIVE THE CARE THEY NEED, AT A LOWER COST, WHEREVER THEY ARE.THROUGHOUT 2018, THE INSTITUTE ENGAGED WITH A BROAD ARRAY OF KEY STAKEHOLDERS INCLUDING HEALTH PLANS, ACCOUNTABLE CARE ORGANIZATIONS (ACOS), CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS), COMMUNITY ORGANIZATIONS AND OTHERS TO ADDRESS THE SKY-ROCKETING COST OF HEALTHCARE BY ELIMINATING OPEN-ENDED, FEE-FOR-SERVICE AND VOLUME-ORIENTED PAYMENT METHODS; AND ADVOCATING FOR POLICIES THAT LOWER PRESCRIPTION DRUG PRICES AND INCREASE PRICING TRANSPARENCY.THE INSTITUTE HAS THE FOLLOWING ACTIVE RESEARCH FOCUS AREAS:1. ADVANCING SENIOR-APPROPRIATE ACUTE CARE MODELS - THE INSTITUTE IS RESEARCHING HOW PROVIDING SENIOR-FOCUSED CARE IN AN ACUTE SETTING, SUCH AS IN THE EMERGENCY DEPARTMENT, HOME AND COMMUNITY, CAN HELP SENIORS AGE SUCCESSFULLY.2. ADVANCING SENIOR-APPROPRIATE CHRONIC CARE MODELS - THE INSTITUTE IS EXPLORING HOW TO IMPROVE CARE FOR SENIORS WITH LONG TERM-ILLNESSES AT HOME - WHERE THEY PREFER IT MOST.3. ADVANCING SUPPORTING SERVICES - THE INSTITUTE IS COLLABORATING TO ADVANCE AND INTEGRATE COMMUNITY-BASED SOCIAL SUPPORT PROGRAMS AND NUTRITIONAL SERVICES THAT SUPPORT INDEPENDENCE FOR SENIORS.1. ADVANCING SENIOR-APPROPRIATE ACUTE CARE MODELSIN 2018, THE INSTITUTE EXPANDED ITS RESEARCH TO INCLUDE A NEW VISION FOR UNPLANNED ACUTE CARE. THE INSTITUTE ENVISIONS CARE THAT IS MORE PROACTIVE, OPPORTUNISTIC AND PROVIDES CARE IN PLACE WHENEVER POSSIBLE. WITH ITS COLLABORATORS, THE INSTITUTE CONTINUES TO INCREASE THE NUMBER OF SENIOR-FRIENDLY EDS THROUGH THE NATIONAL ACCREDITATION PROGRAM. THE INSTITUTE IS ALSO EXPANDING EFFORTS TO ADVANCE HOME AND COMMUNITY-BASED ACUTE CARE ALTERNATIVES WITHIN THE CONTEXT OF VALUE-BASED RISK-BEARING ORGANIZATIONS. TAKEN TOGETHER, THE INSTITUTE IS COMMITTED TO CONTINUE ADVANCING INNOVATIVE, PERSON-CENTERED, SCALABLE AND SUSTAINABLE MODELS TO ADDRESS THE ACUTE CARE NEEDS FOR SENIORS IN THE ED, HOME AND COMMUNITY.GERIATRIC EMERGENCY CARE IN COLLABORATION WITH UC SAN DIEGO HEALTH, IN 2016, THE INSTITUTE LAUNCHED THE GARY AND MARY WEST SENIOR EMERGENCY CARE UNIT AT UC SAN DIEGO HEALTH (SECU), ITS FLAGSHIP MODEL IN AN ACUTE GERIATRIC EMERGENCY CARE SETTING. THE MODEL SERVES AS THE SITE OF A MULTI-YEAR RESEARCH INITIATIVE WHERE THE INSTITUTE IS STUDYING HEALTH OUTCOMES AND COST-EFFECTIVENESS OF PROVIDING ENHANCED CARE FOR SENIORS WITHIN THE EMERGENCY ROOM. THESE INCLUDE THE DELIVERY OF GERIATRIC MEDICINE, ACUTE CARE SCREENINGS, URGENT CARE, CASE MANAGEMENT, AND SOCIAL AND PSYCHIATRIC CARE. WITH A FOCUS ON FOSTERING SUCCESSFUL AGING, THE DEPARTMENT ALSO FACILITATES HOME- AND COMMUNITY-BASED CARE OPTIONS WHEN POSSIBLE. SINCE LATE 2016, MORE THAN 13,000 OLDER ADULTS SEEN AT THE GARY AND MARY WEST EMERGENCY DEPARTMENT AT UC SAN DIEGO HEALTH IN LA JOLLA HAVE BEEN SCREENED USING SENIOR-SPECIFIC CARE PROTOCOLS THE INSTITUTE HELPED DEVELOP WITH UC SAN DIEGO HEALTH.IN MAY 2018, THE GARY AND MARY WEST EMERGENCY DEPARTMENT WAS OFFICIALLY ACCREDITED AS A LEVEL-ONE GERIATRIC EMERGENCY DEPARTMENT (GED) BY THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS (ACEP), THE HIGHEST AND MOST COMPREHENSIVE LEVEL. IT WAS THE FIRST EMERGENCY DEPARTMENT WEST OF THE MISSISSIPPI TO RECEIVE THIS LEVEL OF ACCREDITATION AS PART OF AN EFFORT TO IMPROVE THE QUALITY AND STANDARDS OF EMERGENCY CARE PROVIDED TO THE NATION'S ELDERLY PATIENTS.THROUGHOUT 2018, THE INSTITUTE CONDUCTED APPLIED MEDICAL RESEARCH TO EVALUATE THE EFFECTIVENESS OF THIS NEW CARE MODEL AND INITIATED A STUDY FOCUSED ON PATIENT, CLINICAL, AND OPERATIONAL OUTCOMES. THE STUDY ENDED IN THE FALL, AND THE INSTITUTE IS ANALYZING RESULTS TO BE DEVELOPED INTO A MANUSCRIPT FOR PUBLICATION AND DISSEMINATION.GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC)THE INSTITUTE HAS PARTNERED WITH THE JOHN A. HARTFORD FOUNDATION (JAHF) TO ESTABLISH A NATIONAL GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC) OF NINE LEADING GERIATRIC EMERGENCY MEDICINE PROGRAMS TO PROVIDE EARLY EVIDENCE THAT GED GUIDELINE-BASED CARE IMPROVES PATIENT OUTCOMES AND IS COST EFFECTIVE, AS WELL AS BUILD A DATA INFRASTRUCTURE FOR ONGOING RESEARCH AND EVALUATION. PARTICIPATING SITES INCLUDE: MOUNT SINAI MEDICAL CENTER, ST. JOSEPH'S REGIONAL MEDICAL CENTER, NORTHWESTERN MEMORIAL HOSPITAL, AURORA HEALTHCARE SYSTEM, MAGEE WOMEN'S HOSPITAL, UNIVERSITY OF NORTH CAROLINA, UC SAN DIEGO HEALTH, EMORY GRADY HOSPITAL AND YALE UNIVERSITY HOSPITAL.GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION (GEDA) PROGRAMIN COLLABORATION WITH THE INSTITUTE AND JAHF, IN THE FIRST QUARTER OF 2018, ACEP LAUNCHED THE GEDA PROGRAM TO STANDARDIZE SENIOR-FRIENDLY EMERGENCY CARE ACROSS HETEROGENEOUS SETTINGS AND FORMALLY ACCREDIT SITES BASED ON MEASURABLE CRITERIA. TO DATE, 25 EDS HAVE BEEN ACCREDITED ACROSS ALL THREE LEVELS, INCLUDING THE GARY AND MARY WEST EMERGENCY DEPARTMENT AT UC SAN DIEGO HEALTH WHICH EARNED THE HIGHEST LEVEL OF ACCREDITATION (LEVEL 1).TRANSPORT PLUSIN ACCORDANCE WITH THE INSTITUTE'S VISION FOR CARE THAT IS PROACTIVE, OPPORTUNISTIC AND THAT PROVIDES CARE IN PLACE, TRANSPORT PLUS SEEKS TO IMPROVE CARE TRANSITIONS FOR OLDER ADULTS DISCHARGED FROM THE ED AND HOSPITAL. SPECIALLY-TRAINED EMERGENCY MEDICAL TECHNICIANS (EMTS) WHO ARE ALREADY TRANSPORTING OLDER ADULTS HOME FROM THE ED OR HOSPITAL ADDED TWO INTERVENTIONS TO THEIR SERVICES: 1) A HOME FALL SAFETY ASSESSMENT AND 2) A DISCHARGE COMPREHENSION ASSESSMENT. IN 2018, THE INSTITUTE BEGAN WRAPPING UP ITS COLLABORATION WITH THE MOUNT SINAI DEPARTMENT OF EMERGENCY MEDICINE ON THE IMPACT OF IMPROVING TRANSPORT PLUS' PROCESSES AIMED AT INCREASING THE NUMBER OF HOME ASSESSMENTS COMPLETED AND SUBSEQUENT REMEDIATION OF IDENTIFIED RISKS. WITH THE INSTITUTE'S GUIDANCE REGARDING OVERCOMING GAPS IN EDUCATION AND PROCESSES, ENROLLMENT IN THE PROGRAM INCREASED AND 339 EMT/PATIENT ENCOUNTERS WERE CONDUCTED. THE PRELIMINARY RESULTS OF THE STUDY SHOWED A STATISTICALLY SIGNIFICANT DECREASE IN SELF-REPORTED FALLS IN THE TRANSPORT PLUS GROUP COMPARED TO THE CONTROL GROUP. ADDITIONALLY, PATIENT SELF-REPORTING OF RETURN ED VISITS FOUND THAT PATIENTS WHO RECEIVED THE TRANSPORT PLUS INTERVENTION INITIALLY HAD FEWER RETURN ED VISITS COMPARED WITH THE CONTROL GROUP.ACUTE CARE LEARNING AND ACTION NETWORK (LAN) TO MORE DIRECTLY ALIGN INSTITUTE RESEARCH WITH PROVIDERS THAT ARE PROACTIVELY MOVING AWAY FROM THE MEDICARE FEE-FOR-SERVICE PAYMENT MODEL, IN 2018, THE INSTITUTE FORMED COLLABORATIONS WITH SIX ACOS TO DEVELOP SUSTAINABLE INNOVATIONS DESIGNED TO EFFECTIVELY PREPARE FOR SERVING THE ACUTE CARE NEEDS OF OLDER ADULTS (INCLUDING BUT NOT LIMITED TO BELLIN MEMORIAL HOSPITAL AND ATRIUS HEALTH). THESE PARTICULAR ACOS ARE CONTRACTUALLY BOUND TO WRITE CHECKS BACK TO MEDICARE IF THEY FAIL TO SAVE MEDICARE DOLLARS, COMPARED TO A FEE-FOR-SERVICE BASIS. FOUR OF THE ACOS DEVELOPED HOME-BASED ACUTE CARE MODELS AND TWO FOCUSED ON INNOVATIVE EFFORTS IN THE ED AND SKILLED NURSING FACILITIES TO AVOID HOSPITALIZATIONS AND FUTURE ED VISITS. TO ACCELERATE THE EFFORT, THE INSTITUTE ALSO ENGAGED WITH THE INSTITUTE FOR HEALTHCARE IMPROVEMENT (IHI), AN INDEPENDENT NOT-FOR-PROFIT ORGANIZATION WIDELY RECOGNIZED AS A LEADING INNOVATOR AND DRIVER OF RESULTS IN HEALTH AND HEALTHCARE IMPROVEMENT. DELIRIUM RESOURCES FOR THE EMERGENCY DEPARTMENTIN JULY OF 2018, THE INSTITUTE AND INSTITUTE FOR AGING RESEARCH, AN AFFILIATE OF HARVARD SCHOOL OF MEDICINE, CONCLUDED A COMPREHENSIVE LITERATURE REVIEW OF PUBLICLY AVAILABLE DATA ON DELIRIUM SCREENING TO IDENTIFY KNOWLEDGE GAPS AND EXISTING TOOLS/RESOURCES. ADDITIONALLY, THE TEAM CONDUCTED EXPERT INTERVIEWS WITH MULTIDISCIPLINARY ED AND HOSPITAL CLINICIANS TO GAIN A BETTER UNDERSTANDING OF HOW DELIRIUM IS VIEWED AND MANAGED ACROSS VARIOUS SETTINGS. 463621 THE RISING COST OF HEALTHCARE IN THE UNITED STATES IS A GROWING CRISIS OF EPIC PROPORTIONS THAT UNDERMINES AMERICA'S ECONOMY, COMPROMISES CARE, DRAINS RESOURCES, AND THREATENS FINANCIAL SECURITY. INCREASED SPENDING CONTINUES TO IMPACT FAMILY BUDGETS. BLOATED COSTS REDUCE AMERICA'S ABILITY TO INVEST IN OTHER VITAL PROGRAMS. TO TACKLE THIS CRITICAL ISSUE, THE WEST HEALTH INSTITUTE IS LEADING AN EFFORT TO UNDERSTAND WHY THE UNITED STATES IS SPENDING SO MUCH, GAIN IN-DEPTH KNOWLEDGE OF THE COST DRIVERS, AND IDENTIFY POLICIES THAT CAN SLOW THE TRAJECTORY OF COST WHILE IMPROVING PATIENT ACCESS AND QUALITY OF CARE.TO SUPPLEMENT AND BROADEN THE INSTITUTE'S MEDICAL RESEARCH ACTIVITIES, THE INSTITUTE ALSO PARTICIPATED IN PUBLIC EDUCATION AND THE DISSEMINATION OF RESEARCH FINDINGS TO THOSE INTERESTED IN REDUCING THE COST OF HEALTHCARE SERVICES AND DEVELOPING SENIOR-APPROPRIATE ACUTE, LONG-TERM AND CHRONIC CARE MODELS THAT SUPPORT INDEPENDENCE FOR SENIORS. THE INSTITUTE HAS PROMOTED THE DEVELOPMENT AND IMPLEMENTATION OF POLICIES WHICH ADVANCE TRANSITION OF MODELS OF CARE, HOME-BASED PRIMARY CARE AND PAYMENT MODELS THROUGH CONFERENCE PARTICIPATION AND DIRECT INTERACTION WITH POLICYMAKERS IN BOTH THE REGULATORY AND LEGISLATIVE ARENAS. 20181746 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 37 0 1 29 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 5 3 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 CA DE X SALLY HALLAK 8585357000 10350 N TORREY PINES ROAD LA JOLLA CA 92037 X CHARLES SEDERSTROM DIR./SECRETARY THRU 12/14/18 5.00 1.00 X X 0 0 0 GARY L WEST DIRECTOR, CHAIRMAN 15.00 10.00 X 0 0 0 MARK MCCLELLAN DIRECTOR 10.00 5.00 X 0 0 0 MICHAEL SCHATZLEIN MD DIRECTOR 10.00 0.00 X 0 0 0 NICHOLAS VALERIANI DIRECTOR 15.00 5.00 X 0 0 0 THOMAS CULHANE DIRECTOR 0.00 1.00 X 0 0 0 SHELLEY M LYFORD PRESIDENT & CEO 40.00 15.00 X 597132 22917 11807 ZIA AGHA CHIEF MEDICAL OFFICER & EVP 40.00 0.00 X 631184 0 46251 WILLIAM T EARLEY SECRETARY/TREASURER/CAO/GENERAL COUNSEL 40.00 10.00 X 0 418903 42762 VALERIE VOLPE VP GOVT AFFAIRS THRU 3/2018 50.00 0.00 X 0 320292 10877 TIMOTHY LASH EVP/CHIEF STRATEGY OFFICER 40.00 10.00 X 0 590493 35349 DIANA CAMPAU VP COMMUNICATIONS 50.00 0.00 X 0 388169 49092 SALLY HALLAK TREASURER THRU 12/14/18 40.00 10.00 X 0 187822 18793 ADRIAN KWONG DATA SCIENCE ADMINISTRATOR 50.00 0.00 X 188906 0 26762 CHRISTOPHER CROWLEY PROGRAM MANAGER 50.00 0.00 X 220320 0 33618 GREGORY NORMAN SR. 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FASB ASC 740 ALSO PROVIDES RELATED GUIDANCE ON MEASUREMENT, DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, AND DISCLOSURE. THE INSTITUTE HAS APPLIED FASB ASC 740 TO ALL TAX POSITIONS FOR WHICH THE STATUTE OF LIMITATIONS REMAINED OPEN AND DETERMINED THERE WERE NO MATERIAL UNRECOGNIZED TAX BENEFITS. IN ADDITION, THERE HAVE BEEN NO MATERIAL CHANGES IN UNRECOGNIZED BENEFITS SINCE JULY 1, 2008, NOR ARE ANY ANTICIPATED IN THE NEXT TWELVE MONTHS. THERE HAVE BEEN NO RELATED TAX PENALTIES OR INTEREST, WHICH WOULD BE CLASSIFIED AS TAX EXPENSE IN THE STATEMENT OF ACTIVITIES. 1 GARY AND MARY WEST SENIOR SERVICES INC 1706 DESCANSO AVENUE SAN MARCOS CA 92078 850635784 47392 FMV OFFICE SPACE DONATION OF OFFICE SPACE 0 1 PART I, LINE 2: GRANTS WILL ONLY BE MADE TO 501(C)(3) ORGANIZATIONS TO ENSURE THE NON-CASH ITEMS WILL BE USED PROPERLY. X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 SHELLEY M LYFORD PRESIDENT & CEO 450445 22917 127500 0 19187 0 10277 0 1530 0 608939 22917 0 0 ZIA AGHA CHIEF MEDICAL OFFICER & EVP 511822 0 100000 0 19362 0 13750 0 32501 0 677435 0 0 0 WILLIAM T EARLEY SECRETARY/TREASURER/CAO/GENERAL COUN 0 324009 0 75000 0 19894 0 13750 0 29012 0 461665 0 0 VALERIE VOLPE VP GOVT AFFAIRS THRU 3/2018 0 50981 0 56430 0 212881 0 0 0 10877 0 331169 0 0 TIMOTHY LASH EVP/CHIEF STRATEGY OFFICER 0 446618 0 125000 0 18875 0 7115 0 28234 0 625842 0 0 DIANA CAMPAU VP COMMUNICATIONS 0 323745 0 63000 0 1424 0 13750 0 35342 0 437261 0 0 SALLY HALLAK TREASURER THRU 12/14/18 0 163684 0 24000 0 138 0 9440 0 9353 0 206615 0 0 ADRIAN KWONG DATA SCIENCE ADMINISTRATOR 172840 0 15841 0 225 0 8750 0 18012 0 215668 0 0 0 CHRISTOPHER CROWLEY PROGRAM MANAGER 201717 0 17809 0 794 0 11081 0 22537 0 253938 0 0 0 GREGORY NORMAN SR. 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DIRECTOR DATA SCIENCE 215766 0 31950 0 304 0 12567 0 29138 0 289725 0 0 0 JOSEPH SMITH FORMER CO-MANAGER/CMO THRU 3/31/16 0 795346 0 0 0 1118 0 0 0 33218 0 829682 0 0 NANCY SCHROEDER SR DIR COMM THRU 5/17/15 0 167047 0 16974 0 342 0 9548 0 31845 0 225756 0 0 PART I, LINE 1A THE USE OF BUSINESS CLASS MAY BE AUTHORIZED UNDER THE CIRCUMSTANCES LISTED BELOW: (1) INTERNATIONAL TRAVEL; (2) BUSINESS OR FIRST CLASS IS THE ONLY SERVICE OFFERED BETWEEN TWO POINTS; (3) COACH CLASS WOULD BE MORE EXPENSIVE OR TIME CONSUMING, E.G., WHEN, BECAUSE OF SCHEDULING DIFFICULTIES, TRAVELING BY COACH WOULD REQUIRE AN UNNECESSARY HOTEL EXPENSE, CIRCUITOUS ROUTING (2 OR MORE LAYOVERS), OR AN UNDULY LONG LAYOVER WHEN MAKING CONNECTIONS; (4) AN ITINERARY INVOLVES OVERNIGHT TRAVEL WITHOUT THE OPPORTUNITY FOR NORMAL REST BEFORE THE COMMENCEMENT OF WORKING HOURS; OR (5) THE USE OF BUSINESS CLASS IS NECESSARY TO REASONABLY ACCOMMODATE A DISABILITY OR MEDICAL NEED OF A TRAVELER. PART I, LINES 4A-B VALERIE VOLPE, VICE PRESIDENT OF GOVERNMENT AFFAIRS WAS TERMINATED MARCH 2018 FROM A RELATED ORGANIZATION, WEST MANAGEMENT COMPANY, INC. HER SEVERANCE PAYMENT WAS $175,500 IN ACCORDANCE WITH THE RESPECTIVE SEPARATION AGREEMENT. PART I, LINES 4A-B EACH OF THE FOLLOWING INDIVIDUALS ZIA AGHA AND SHELLEY M. LYFORD (LISTED ON SCHEDULE J) PARTICIPATED IN THE 457(B) NONQUALIFIED DEFINED CONTRIBUTION PLAN OFFERED BY THE WEST HEALTH INSTITUTE. THE GARY AND MARY WEST HEALTH INSTITUTE MAKES AN ANNUAL CASH CONTRIBUTION FOR EACH EMPLOYEE IN AN AMOUNT EQUAL TO THE APPLICABLE DOLLAR AMOUNT IN EFFECT FOR THAT YEAR. FOR 2018 THIS AMOUNT WAS $18,500. CONTRIBUTIONS WERE MADE FOR ZIA AGHA AND SHELLEY LYFORD. THE FOLLOWING EMPLOYEES LISTED ON SCHEDULE J PARTICIPATED IN THE 409A NONQUALIFIED DEFINED CONTRIBUTION PLAN OFFERED BY THE GARY AND MARY WEST MANAGEMENT COMPANY, INC., A RELATED ORGANIZATION. THE WEST MANAGEMENT COMPANY MAKES A CASH CONTRIBUTION FOR EACH EMPLOYEE IN AN AMOUNT EQUAL TO THE APPLICABLE DOLLAR AMOUNT IN EFFECT. FOR 2018 THIS AMOUNT WAS $18,500: CONTRIBUTIONS WERE MADE FOR WILLIAM EARLEY AND TIMOTHY LASH. PART I, LINE 7 EACH OF THE MANAGERS IS ELIGIBLE FOR AN ANNUAL DISCRETIONARY BONUS, SUBJECT TO BOARD APPROVAL, WHICH IS BASED ON INDIVIDUAL PERFORMANCE AND LIMITED TO A MAXIMUM PERCENTAGE OF BASE COMPENSATION. SEE PART V DISCLOSURE 0 PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS GARY WEST, CHAIRMAN OF THE WEST HEALTH INSTITUTE, IS A MEMBER OF WEST DEVELOPMENT, LLC. GARY WEST IS TREATED AS AN INTERESTED PERSON FOR PURPOSES OF SCHEDULE L, PART IV, ADDRESSING BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS. THERE WERE BUSINESS TRANSACTIONS BETWEEN THE INSTITITUE AND WEST DEVELOPMENT, LLC DURING 2018, BUT THE MAGNITUDE OF THE TRANSACTIONS WAS LESS THAN THAT REQUIRING DISCLOSURE ON SCHEDULE L. PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS GARY AND MARY WEST SENIOR SERVICES, INC. ("GMWSS") AND WEST HEALTH INSTITUTE ("WHI")SHARE A COMMON OFFICER, TIMOTHY LASH. IN 2018, GMWSS AND WHI ENTERED INTO A RESEARCH COLLABORATION AGREEMENT VALUED AT 2,765,000. FORM 990, PART III, LINE 4A US ACUTE CARE SOLUTIONS US ACUTE CARE SOLUTIONS (USACS) IS A NATIONAL PHYSICIAN-OWNED ACUTE CARE PROVIDER OF ED, OBSERVATION, HOSPITALIST, AND CRITICAL CARE SOLUTIONS ACROSS OVER TWO HUNDRED SITES IN THE UNITED STATES. IN JUNE 2018, THE INSTITUTE INITIATED A PILOT PROJECT TO TRAIN FOUR GED NURSES ACROSS TWO EDS (TAMPA, FL AND STAMFORD, CT), DRAFT A BUSINESS CASE OUTLINING THE VALUE PROPOSITION OF GEDS, AND ACHIEVE GED NATIONAL ACCREDITATION. IN 2018, ALL NURSES COMPLETED THE TRAINING AND HAVE IMPLEMENTED THE GED PROTOCOLS AT BOTH SITES. ONSITE ACUTE CARE FOR SENIORS IN SKILLED NURSING FACILITIES IN 2018, THE INSTITUTE LAUNCHED A COLLABORATION WITH BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) AND CALL9, A TECHNOLOGY-ENABLED HEALTH PROVIDER WHICH PROVIDES ACUTE CARE TO SENIORS IN SKILLED NURSING FACILITIES. BY EXTENDING THE INSTITUTE'S VISON OF PROACTIVE CARE IN PLACE TO THE NURSING HOME SETTING, THIS COLLABORATION EMBRACES SOME OF THE MOST VULNERABLE SENIORS AND PROVIDES NEW OPTIONS-WHERE APPROPRIATE-TO AVOID DIFFICULT ED TRANSFERS AND HOSPITAL ADMISSIONS. IN THE NURSING HOME SETTING, CALL9 USES A CLOUD-BASED TELEHEALTH PLATFORM AND AN ON-SITE MOBILE EMERGENCY KIT, COMPRISING AN EKG, ULTRASOUND, ISTAT (LABS) AND OTHER EQUIPMENT. THE PROGRAM ALLOWS ONSITE STAFF TO REACH A CALL9 EMERGENCY DOCTOR AS AN ALTERNATIVE TO CALLING 911. WORKING TOGETHER WITH BIDMC, THE INSTITUTE IS CONDUCTING A COMPREHENSIVE EVALUATION OF THE CALL9 PROGRAM'S ECONOMIC IMPACT. PRELIMINARY RESULTS SUGGEST THAT THE REDUCED HOSPITAL ADMISSIONS OFFER A SIGNIFICANT SAVINGS OVER THE TRADITIONAL CARE PATHWAYS. MOUNT SINAI: BUILDING HOSPITAL AT HOME AND REHABILITATION AT HOME SERVICES HOSPITAL AT HOME (HAH) PROGRAMS PROVIDE SENIORS AND OTHER AT-RISK PATIENTS WITH HOME-BASED CARE BETTER MATCHED TO THEIR WISHES AND NEEDS, WHILE ALSO PROVIDING A LOWER COST ALTERNATIVE TO HOSPITALIZATIONS. NUMEROUS CONDITIONS COMMON TO OLDER ADULTS INCLUDING TREATMENT OF EXACERBATIONS OF CHRONIC DISEASES HAVE BEEN EFFECTIVELY TREATED IN THE COMFORT AND SAFETY OF THE HOME SETTING. ESTABLISHED BENEFITS INCLUDE SHORTER LENGTHS OF ACUTE TREATMENT, LOWER RATES OF 30-DAY HOSPITAL ADMISSIONS/READMISSIONS, EMERGENCY DEPARTMENT VISITS, AND SKILLED NURSING FACILITY ADMISSIONS AS WELL AS BETTER PATIENT EXPERIENCES. THERE HAVE BEEN EXPERIENCES AT MOUNT SINAI IN COMBINING THE HAH PROGRAM WITH REHABILITATION AT HOME (RAH) (PROVIDING SUBACUTE SERVICES AT HOME)-A PROGRAM THAT ALLOWS FOR SHARING OF STAFFING INFRASTRUCTURE WHILE PROVIDING A NEEDED SERVICE TO PATIENTS. EFFORTS TO DEVELOP A BUNDLED PAYMENT FOR HAH EPISODES PLUS 30-DAY CARE HAVE BEEN ESTABLISHED WITH SOME COMMERCIAL INSURANCE COMPANIES, WHILE EFFORTS TO SECURE THE HAH MODEL AS A PERMANENT PAID BENEFIT IN TRADITIONAL MEDICARE ARE ONGOING. THE HAH PAYMENT BUNDLE IS CURRENTLY NOT AVAILABLE TO MOST POTENTIALLY ELIGIBLE BENEFICIARIES, INCLUDING MOST TRADITIONAL MEDICARE PATIENTS. A PAYMENT METHOD FOR RAH IS SIMILARLY LACKING. FOR THIS REASON, IN 2018, THE INSTITUTE COLLABORATED ON A STUDY OF HOW PAYMENT FOR HAH AND RAH SERVICES MIGHT BE RESTRUCTURED OUT OF EXISTING MEDICARE AND OTHER FEE-FOR-SERVICE ORIENTED PAYMENT MECHANISMS. THE RESULTS WILL AID THE UNDERSTANDING OF THE BREADTH OF OPPORTUNITY FOR PROVIDING HAH AND RAH CARE TO A LARGER NUMBER OF MEDICARE BENEFICIARIES PARTICULARLY THOSE IN VALUE AND RISK-BASED ARRANGEMENTS, SUCH AS ACOS, USING THE EXISTING "CHASSIS" OF MEDICARE FEE-FOR-SERVICE REIMBURSEMENT. IMPORTANTLY, FINDINGS FROM THE STUDY COULD ALSO SUPPORT CLARITY ON SPECIFIC GAPS IN COVERAGE (NECESSARY SERVICES OR TREATMENTS WITH NO REIMBURSEMENT MECHANISM WHEN DELIVERED IN A HOME SETTING), WHICH COULD IN TURN PROVIDE BETTER SPECIFICITY TO SUPPORT THE ONGOING MESSAGING BACK TO MEDICARE CONCERNING THE NEED FOR A COMPREHENSIVE BUNDLED PAYMENT, OR ALTERNATIVE PROVISIONS THAT DIRECTLY EXPLOIT THIS OPPORTUNITY FOR LOWERING THE COST OF HEALTHCARE. TELEHEALTH THE INSTITUTE CONTINUES TO IDENTIFY WAYS TO ACCELERATE AND SCALE TELEHEALTH INITIATIVES THAT DEMONSTRATE IMPROVED OUTCOMES FOR SENIORS AND PROMOTE SUCCESSFUL AGING. OBJECTIVES INCLUDE EXPANDING INFORMATION ON OPERATIONS AND POLICY AND DISSEMINATING KNOWLEDGE OF IMPLEMENTATION AND APPLIED MEDICAL RESEARCH. RESEARCH MILESTONES IN 2018 INCLUDED: -INITIATION OF A TELEHEALTH IMPLEMENTATION MANUAL IN COLLABORATION WITH NATIONALLY-RECOGNIZED TELEHEALTH LEADERS ACROSS NINE ORGANIZATIONS THAT CARE FOR OVER 1.5 MILLION PATIENT LIVES ACROSS 31 STATES. -COMMENCEMENT OF THE FIRST MULTI-ORGANIZATIONAL TELEHEALTH RESEARCH PROJECT TO DEMONSTRATE THE CLINICAL IMPACT OF TELEHEALTH TO ADDRESS URGENT/ NON-EMERGENT CONDITIONS FOR SENIORS. -COMPLETION OF A PILOT PROJECT DEMONSTRATING TELEHEALTH IN ASSISTED LIVING FACILITIES. -CO-HOSTED AND SPONSORED THE NATION'S ONLY TELEHEALTH RESEARCH FOCUSED SUMMIT WITH 150 ATTENDEES ACROSS 60 ORGANIZATIONS NATIONALLY. THE AGENDA CONCENTRATED ON SENIOR AND VULNERABLE PATIENTS, OUTCOMES, POLICY, VALUE AND COST OF HEALTHCARE, WHICH INCREASED THE INSTITUTE'S REPUTATION AND RECOGNITION NATIONALLY WHILE PROMOTING VALUE-BASED MODELS THAT USE TELEHEALTH FOR SENIORS. -POLICY-RELATED EFFORTS INCLUDED CONVENING KEY STAKEHOLDERS AND AUTHORING COMMENT LETTERS FOR CHANGES TO MEDI-CAL TELEHEALTH COVERAGE AND OUR POSITION ON THE REDUCING UNNECESSARY SENIOR HOSPITALIZATION ACT (RUSH) ACT OF 2018, (H.R. 6502). -EDUCATION AND OUTREACH INCLUDE OVER 10 PRESENTATIONS AT NATIONAL CONFERENCES, MEDIA INTERVIEW AND A BLOG POST ON THE NATION'S LARGEST AND MOST NOTABLE TELEHEALTH ORGANIZATION. -COMPLETING PHASE II OF THE TELEHEALTH LANDSCAPE REVIEW WITH THE CENTER FOR CONNECTED HEALTH POLICY (CCHP) AND IDENTIFYING TWO HIGH-VALUE EFFORTS, WHICH WILL INCLUDE COLLABORATIONS WITH CCHP AND OTHER HEALTH SYSTEMS. -CONDUCTING ONGOING MARKET INTELLIGENCE EVALUATION AND REFINEMENT OF STRATEGY UTILIZING SIGNALS ANALYTICS TO CONDUCT STATE-BY-STATE LEVEL ANALYSIS OF PAYERS AND PARITY LAWS AND IDENTIFYING TELEHEALTH FRIENDLY STATES TO TARGET FOR RESEARCH. IN 2018, THE INSTITUTE ALSO CONCLUDED A THREE-SITE RESEARCH STUDY EVALUATING TELEHEALTH SERVICES IN ASSISTED LIVING FACILITIES. RESIDENTS WITHIN EACH COMMUNITY WERE OFFERED TELEHEALTH CONSULTATIONS WITH PHYSICIANS ACROSS URGENT/EMERGENT CARE, GERIATRICS, PSYCHIATRY AND PHARMACY. IN TOTAL, 215 RESIDENTS WERE ENROLLED IN THE STUDY AND OVER 120 TELEHEALTH VISITS WERE CONDUCTED. 2. ADVANCING SENIOR-APPROPRIATE CHRONIC CARE MODELS THE INSTITUTE CONTINUES TO EXPLORE OPPORTUNITIES FOR ADVANCING CHRONIC CARE SOLUTIONS FOR OUR NATION'S SENIORS. BY IMPROVING CARE TRANSITIONS, PRODUCING BETTER PATIENT OUTCOMES AND INCREASING EFFICIENCY, THIS WORK CAN HELP MORE BENEFICIARIES WITH CHRONIC CONDITIONS RECEIVE CARE IN THEIR OWN HOMES. IN 2018, THE INSTITUTE ENGAGED IN APPLIED MEDICAL RESEARCH PROJECTS FOCUSED ON SENIOR-SPECIFIC MODELS OF CARE WITHIN THE CHRONIC CARE SETTING IN THESE AREAS: A. ORAL HEALTHCARE AND CARE COORDINATION B. CAREGIVERS C. PALLIATIVE CARE D. HOME-BASED PRIMARY CARE A. ORAL HEALTHCARE AND CARE COORDINATION IN CALIFORNIA AND ACROSS THE NATION, MANY SENIORS CANNOT AFFORD DENTAL CARE. MEDICARE, THE PRIMARY HEALTH INSURER FOR SENIORS, DOES NOT COVER ROUTINE DENTAL CARE. ALTHOUGH MEDICAID COVERAGE FOR DENTAL CARE IS AVAILABLE FOR LOW-INCOME SENIORS IN CALIFORNIA THROUGH DENTI-CAL, LOW REIMBURSEMENT RATES AND ADMINISTRATIVE OBSTRUCTIONS RESULT IN SIGNIFICANT GAPS IN DENTAL PROVIDERS WILLING TO PARTICIPATE. THE INSTITUTE IS ADDRESSING THE CRITICAL NEED FOR IMPROVED ORAL HEALTHCARE FOR VULNERABLE SENIORS THROUGH ITS APPLIED MEDICAL RESEARCH WITH COLLABORATORS. THE INSTITUTE ALSO CONTINUED ITS FOCUS ON IMPROVING ORAL HEALTHCARE FOR SENIORS IN 2018. THE INSTITUTE BECAME AN ACTIVE CONTRIBUTOR TO CALIFORNIA'S ORAL HEALTH NETWORK, HOSTING A REGIONAL SAN DIEGO CONVENING IN FEBRUARY 2018, WHICH FOCUSED ON STATE ORAL HEALTH POLICY AND HEALTH EQUITY. APPLE TREE DENTAL IN 2017, THE INSTITUTE INITIATED A PARTNERSHIP AND RESEARCH COLLABORATION WITH APPLE TREE DENTAL (ATD), A MINNESOTA-BASED PROVIDER OF INTEGRATED DENTAL SERVICES TO VULNERABLE POPULATIONS, PARTICULARLY LOW-INCOME SENIORS. ATD HAS PROVIDED SERVICES FOR OVER 30 YEARS AND HAS THOUSANDS OF RECORDED PATIENTS WHO ARE OLDER ADULTS. THIS STUDY IS UTILIZING RETROSPECTIVE DATA FROM ATD TO EXAMINE DIFFERENCES IN CARE FOR OLDER AND VULNERABLE ADULTS TO DEVELOP POTENTIAL RISK OR PAYMENT MODIFIERS AND DISCOVER ALTERNATE METHODS, WHICH MAY BE MORE EFFICIENT OR EFFECTIVE TO EXPAND SERVICES TO OLDER ADULTS. ADDITIONALLY, THE INSTITUTE IS CONTINUING A STUDY WITH ATD TO ANALYZE AND DISCOVER INNOVATIVE MODELS OF SENIOR DENTAL CARE, WITH THE GOAL OF DEVELOPING RISK/UTILIZATION MODELS AND DISCOVERING THE EVIDENCE TO SUPPORT THE VALUE PROPOSITION OF PROVIDING ACCESS TO QUALITY ORAL HEALTHCARE FOR OLDER ADULTS. FORM 990, PART III, LINE 4A IN THE FALL OF 2018, ANALYSIS ON A SAMPLE OF 2,932 SENIORS TREATED AT ATD BETWEEN 2012 AND 2017 WAS CONDUCTED. PREPARATION, DE-IDENTIFICATION AND EXPORT OF THE SAMPLE OCCURRED IN THE SPRING 2018. A DRAFT REPORT DELIVERED IN DECEMBER 2018 IDENTIFIES THE INITIAL COST OF DENTAL CARE FOR SENIORS IS MODEST AND IS COMPARABLE BETWEEN THOSE RECEIVING CARE IN OUTPATIENT SETTINGS AND LONG-TERM CARE FACILITIES. B. CAREGIVERS CAREGIVERS REPRESENT A CRITICAL COMPONENT OF SUCCESSFUL AGING, COMPRISING FAMILY MEMBERS, NONFAMILY MEMBERS AND PAID HELPERS. TRADITIONALLY CONSIDERED AS UNPAID FAMILY MEMBERS, CAREGIVERS REPRESENT A MUCH LARGER COMMUNITY OF PROFESSIONAL AND NONPROFESSIONAL PROVIDERS AND INCLUDES ANYONE DELIVERING COMMUNITY-BASED SERVICES TO AGING ADULTS SUCH AS MEDICAL CARE, SUPPORT OF DAILY LIVING ACTIVITIES AND OTHER BASIC NEEDS. ACCORDING TO A RECENT NATIONAL ALLIANCE FOR CAREGIVING RESEARCH REPORT, 57 PERCENT OF CAREGIVERS PERFORM MEDICAL OR NURSING DUTIES, INCLUDING DIFFICULT TASKS SUCH AS FEEDING TUBE INSERTION, WOUND DRESSING, DOSE TITRATION AND INJECTION MANAGEMENT. DESPITE THE COMPLEXITY OF PROVIDING THIS TYPE OF CARE, THERE IS LITTLE COORDINATION BETWEEN CAREGIVERS AND THE FORMAL HEALTHCARE INFRASTRUCTURE. WITH MANY CAREGIVERS FACING THE CHALLENGES OF THEIR OWN AGING, NOW MORE THAN EVER, IT IS IMPERATIVE TO IDENTIFY AND ADVANCE MORE COMPREHENSIVE, CROSS-DISCIPLINARY CAREGIVER SOLUTIONS-INNOVATIVE PROGRAMS ADDRESSING THE NEEDS OF BOTH CAREGIVERS AND THE RECIPIENTS OF CARE, ENSURING THE FOUNDATIONS OF SUCCESSFUL AGING ARE MORE FULLY REALIZED. THE INSTITUTE IS RESEARCHING OPPORTUNITIES TO INTEGRATE AND ALIGN THE EFFORTS OF CAREGIVERS, HEALTHCARE PROVIDERS AND SYSTEMS TO REDUCE THE BURDEN, HELP ENSURE COORDINATION AMONG EFFORTS AND ENABLE ACCESS TO MORE CONTINUOUS, COMMUNITY-BASED CARE THAT IS BETTER ALIGNED WITH EMERGING PATIENT NEEDS AND CORRESPONDING VALUE-BASED INCENTIVES. FAMILY CAREGIVER TRAINING & SUPPORT IN 2016, THE INSTITUTE LAUNCHED A THREE-YEAR CAREGIVER EDUCATION PROJECT WITH THE CENTER TO ADVANCE PALLIATIVE CARE (CAPC), ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI IN NEW YORK. THE ORIGINAL PROJECT AIM WAS TO PROVIDE CAREGIVERS WITH JUST-IN-TIME RESOURCES AND LEARNING MODULES RELATED TO CARING FOR A LOVED ONE WITH DEMENTIA. THE INSTITUTE'S FORMATIVE RESEARCH IN THE FIRST YEAR OF THE PROJECT REVEALED THE TRAINING FORMAT IN THE INITIAL PROPOSAL-ONLINE COURSES FOR FAMILY CAREGIVERS-WAS NOT A METHOD OF LEARNING THAT THE AUDIENCE CONSIDERED BENEFICIAL. WE FOUND FAMILY CAREGIVERS WERE NOT USING ONLINE RESOURCES AND THE ONLINE RESOURCES THAT DO EXIST HAVE LOW ATTENDANCE SUGGESTING LIMITED SUCCESS IN REACHING FAMILY CAREGIVERS AT SCALE. GIVEN THAT CLINICIANS ARE CAREGIVERS AND PATIENTS' MOST-TRUSTED SOURCE OF INFORMATION AND THEIR PRIMARY POINT OF CONTACT FOR DEMENTIA CARE, THE INSTITUTE SHIFTED FOCUS TO CREATE A SERIES OF ONLINE TRAINING MODULES FOR ALL CLINICIANS TO TALK WITH PATIENTS, FAMILY MEMBERS, AND OTHER CAREGIVERS ABOUT DEMENTIA. THE NEW CURRICULUM, BEST PRACTICES IN DEMENTIA CARE AND CAREGIVER SUPPORT, AND THE FIRST THREE OF SEVEN COURSES WERE RELEASED ON AUGUST 1ST OF 2018. THESE COURSES WERE ENTITLED: -"DISCUSSING YOUR PATIENT'S DEMENTIA DIAGNOSIS; -"COMMUNICATING ABOUT WHAT TO EXPECT AS DEMENTIA PROGRESSES; AND -"UNDERSTANDING AND RESPONDING TO BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA." AS OF DECEMBER 2018, OVER 1,000 HEALTHCARE PROFESSIONALS HAVE COMPLETED THE COURSES. WITH NEARLY 300 COURSE COMPLETIONS PER MONTH (FOR FIRST COURSE), THIS COMPLETION RATE EXCEEDS THAT OF MANY OF CAPC'S SPECIALIZED COURSES (E.G., HEART FAILURE 190 AVERAGE/MONTH, ADVANCE CARE PLANNING 250/MONTH, COPD 184/MONTH). C. PALLIATIVE CARE PALLIATIVE CARE PROVIDES AN EXTRA LAYER OF SUPPORT FOR THE SERIOUSLY ILL, GIVING THEM RELIEF FROM SYMPTOMS AND THE STRESS OF DISEASE BURDEN, ULTIMATELY IMPROVING THE PATIENT'S AND FAMILY'S QUALITY OF LIFE. PALLIATIVE CARE HAS EXPANDED INTO THE HOSPITAL SETTING WITH INCREASING NUMBER OF HOSPITALS HAVING PALLIATIVE CARE TEAMS AVAILABLE FOR PATIENTS. THE INSTITUTE IS DEVELOPING AND IMPLEMENTING A MODEL OF HOME-BASED PALLIATIVE CARE, WHICH INCLUDES HOME VISITS AND TELEMEDICINE SUPPORT TO IMPROVE CARE FOR SENIORS. THE OBJECTIVE OF THE INSTITUTE'S RESEARCH IS TO HIGHLIGHT THE NEED FOR HOME- AND COMMUNITY-BASED MODELS OF PALLIATIVE CARE, IDENTIFY ALTERNATIVE METHODS OF PAYMENT AND DEVELOP A SUSTAINABLE HOME- AND COMMUNITY-BASED PALLIATIVE CARE PROGRAM. IN 2016, THE INSTITUTE LAUNCHED A FIVE-YEAR PROJECT WITH THE ICAHN SCHOOL OF MEDICINE AT MT. SINAI FOCUSED ON CREATING, DELIVERING AND EVALUATING A CLINICAL MODEL WHICH PROVIDES PALLIATIVE CARE TO PATIENTS IN THEIR HOME. IN 2017, THE RESEARCH STUDY FOCUSED ON THE DEVELOPMENT OF A RISK STRATIFICATION MODEL TO IDENTIFY THE APPROPRIATE PATIENTS FOR HOME-BASED PALLIATIVE CARE, AND OPERATIONALIZING CLINICAL PATHWAYS FOR DELIVERY OF CARE USING COMMUNITY HEALTH WORKERS AND TELEMEDICINE. IN 2018, THE TEAM TRAINED THE CLINICAL STAFF FOR IMPLEMENTING THE PALLIATIVE PROGRAM AND PILOTED THE HOME-BASED PALLIATIVE CARE MODEL WITH TEN PATIENTS. THE RANDOMIZED CONTROLLED TRIAL TO EVALUATE THE PROGRAM COMPARED TO A USUAL CARE CONTROL GROUP WAS LAUNCHED IN AUGUST OF 2018. ADVANCING THE NEXT GENERATION OF PALLIATIVE CARE HEALTHCARE PROFESSIONALS IN 2018, THE INSTITUTE CONTINUED ITS STRATEGIC AFFILIATION WITH CALIFORNIA STATE UNIVERSITY'S PALLIATIVE CARE INSTITUTE AT SAN MARCOS BY SUPPORTING THE THIRD ANNUAL NATIONAL SYMPOSIUM FOR ACADEMIC PALLIATIVE CARE, EDUCATION, AND RESEARCH. ATTENDED BY 222 INDIVIDUALS-A 39% ATTENDANCE INCREASE OVER 2017-THE CONFERENCE REMAINS UNIQUELY FOCUSED ON EDUCATING AND TRAINING THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS. ATTENDEES WERE COMPRISED OF CLINICIANS, ACADEMIC FACULTY, AND RESEARCHERS. THE INSTITUTE WORKED WITH THE PALLIATIVE CARE INSTITUTE TO DEVELOP THE PROGRAM AGENDA AND REVIEWED SUBMITTED ABSTRACTS FOR PRESENTATION AT THE SYMPOSIUM. THE INSTITUTE ALSO DEVELOPED AND SPONSORED A MULTI-DISCIPLINARY PANEL TITLED, "SUPPORTING FAMILY CAREGIVERS OF SERIOUSLY ILL SENIORS: RESEARCH, TRAINING AND COMMUNITY CONNECTIONS." THE PANEL DISCUSSED THE CURRENT STATE AND NEEDS OF FAMILY CAREGIVERS, WAYS TO CONNECT PATIENTS AND CAREGIVERS WITH COMMUNITY RESOURCES, AND GAPS THAT NEED TO BE ADDRESSED THROUGH RESEARCH AND TRAINING. BLUE SHIELD STUDY BLUE SHIELD OF CALIFORNIA (BLUE SHIELD) IS CURRENTLY CONTRACTING WITH ITS PROVIDERS ACROSS CALIFORNIA TO DELIVER HOME-BASED PALLIATIVE CARE TO SERIOUSLY ILL INDIVIDUALS AS A BENEFIT IN THEIR PLAN. IN 2018, THE INSTITUTE CONDUCTED A SURVEY WITH THESE HEALTH PLANS TO CREATE A BASELINE UNDERSTANDING OF OPPORTUNITIES AND CHALLENGES THEY FACE IN DEVELOPING SCALABLE IN-HOME PALLIATIVE CARE MODELS. IN SEPTEMBER 2018, THE INSTITUTE COMMENCED A RESEARCH STUDY WITH BLUE SHIELD TO IDENTIFY THE RETURN ON INVESTMENT OF IMPLEMENTING AN IN-HOME PALLIATIVE CARE PROGRAM WITHIN A HEALTH PLAN. AS PART OF THE STUDY, THE INSTITUTE IS SERVING AS AN INDEPENDENT EVALUATOR OF THE PROGRAM AND IS INVESTIGATING THE 49,000 LIVES COVERED BY BLUE SHIELD OF CALIFORNIA CURRENTLY ELIGIBLE FOR HOME-BASED PALLIATIVE CARE, AND WHAT FACTORS INFLUENCE ENROLLMENT INTO THE PROGRAM. TO BROADLY DISSEMINATE RESEARCH FINDINGS, THE INSTITUTE IS FACILITATING BEST PRACTICE SHARING THROUGH A NATIONAL BLUE SHIELD PALLIATIVE CARE WORKGROUP, WHICH BEGAN IN 2017, INCLUDING MORE THAN 20 BLUE SHIELD HEALTH PLANS ACROSS THE COUNTRY. D. HOME-BASED PRIMARY CARE CHRONIC CARE FOR THE FRAIL ELDERLY REQUIRES ONGOING, LOW-INTENSITY SUPPORT, MUCH OF IT NOT STRICTLY MEDICAL, WHICH IS IN STARK CONTRAST TO ACUTE CARE DELIVERED IN U.S. HOSPITAL SYSTEMS. HOME-BASED PRIMARY CARE (HBPC) IS A MULTIDISCIPLINARY ONGOING CARE STRATEGY FOR PROVIDING IN-HOME TREATMENT PRIMARILY TO ADDRESS MEDICALLY-COMPLEX HOMEBOUND SENIORS' NEEDS. RECENT STUDIES HAVE DEMONSTRATED THAT HBPC CAN BE A COST-EFFECTIVE STRATEGY FOR DELIVERING CARE TO FRAIL PATIENTS WHILE MAINTAINING OR IMPROVING QUALITY OF CARE AND PATIENT SATISFACTION. DELIVERING HBPC PRESENTS CHALLENGES THAT INCLUDE INADEQUATE PROVIDER COMPENSATION, WORKFORCE SHORTAGES AND HIGH DEMAND FOR SERVICES. COMPENSATION FOR HOME MEDICAL CARE HAS PRIMARILY BEEN THROUGH FEE-FOR-SERVICE MEDICARE, WHICH IS INADEQUATE TO COVER THE COST OF SERVICES DELIVERED OUTSIDE THE HOME VISIT, YET NECESSARY TO MEET THE COMPLEX NEEDS OF HOMEBOUND PATIENTS. ONGOING SUPPORT OF INDEPENDENCE AT HOME (IAH) IN 2017, THE INSTITUTE COLLABORATED WITH THE UNIVERSITY OF PENNSYLVANIA TO CONDUCT AN ANALYSIS OF THE SHARED SAVINGS METHODOLOGY FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES' (CMS) INDEPENDENCE AT HOME (IAH) DEMONSTRATION TO DETERMINE THE APPROPRIATE RISK ADJUSTMENT AND SAVINGS MODEL FOR PRACTICES PARTICIPATING IN IAH. IN 2018, THE INSTITUTE COMPLETED ITS WORK ON THE SHARED SAVINGS METHODOLOGY FOR CMS' INDEPENDENCE AT HOME (IAH) DEMONSTRATION. FORM 990, PART III, LINE 4A IN FEBRUARY, CONGRESS PASSED A TWO-YEAR EXTENSION OF IAH. SOME OF THE RECOMMENDATIONS MADE TO CMS, BASED ON THE INSTITUTE'S ANALYSIS OF THE SHARED SAVINGS METHODOLOGY WILL BE INCORPORATED INTO HOW THE PAYMENT MODEL IS CALCULATED FOR THE DEMONSTRATION EXTENSION. THE INSTITUTE CONDUCTED ADDITIONAL ANALYSES ON THE GREATER DIFFICULTY FACED BY SMALL HOME-BASED PRIMARY CARE PRACTICES HAVE IN REALIZING SHARED SAVINGS COMPARED TO LARGER PRACTICES. QUALIFIED CLINICAL DATA REGISTRY (QCDR) FOR HBPC PRACTICES IN 2016, THE INSTITUTE BEGAN A COLLABORATION WITH THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO; JOHNS HOPKINS UNIVERSITY; AND THE JOHN A. HARTFORD FOUNDATION (JAHF) TO ESTABLISH A QCDR FOR HOME-BASED PRIMARY CARE AND PALLIATIVE CARE MEDICINE. THE NATIONAL HOME-BASED PRIMARY CARE AND PALLIATIVE CARE REGISTRY AND ITS CUSTOM MEASURES FOR HOME-BASED CARE OF MEDICALLY COMPLEX FRAIL SENIORS HAS BEEN SUCCESSFULLY APPROVED EACH YEAR BY CMS AS A QCDR, WHICH ALLOWS PRACTITIONERS OF HOME-CARE MEDICINE TO PARTICIPATE IN VALUE-BASED PAYMENTS AND QUALITY IMPROVEMENT ACTIVITIES. IN 2018, THE INSTITUTE CONTINUED TO COLLABORATE WITH THESE RESEARCH PARTNERS TO DEVELOP THE E-SPECIFICATIONS FOR THE CUSTOM QUALITY MEASURES. THE QCDR WILL BE THE CORNERSTONE OF A LEARNING COLLABORATIVE OF NINE ADDITIONAL HOME-BASED PRIMARY AND PALLIATIVE CARE PRACTICES THAT WILL BE CONTRIBUTING DATA TO THE REGISTRY BEGINNING IN EARLY 2019. TO SUPPORT THE LEARNING COLLABORATIVE, IN 2018, THE INSTITUTE AND PARTNERS HAVE DEVELOPED A STAND-ALONE WEBSITE TO PROVIDE PUBLIC RESOURCES ON HOME-BASED PRIMARY AND PALLIATIVE CARE, AND PRIVATE RESOURCES FOR THOSE PRACTICES JOINING THE REGISTRY. FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH IN APRIL 2017, THE INSTITUTE LAUNCHED A FOUR-YEAR RESEARCH PROJECT WITH THE FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH AND NORTHWELL HEALTH'S HOUSE CALLS PROGRAM, "HOME-BASED MONITORING TO ENHANCE AND SCALE A HIGH-TOUCH HOME-BASED PRIMARY CARE PROGRAM." THE RESEARCH AIMS TO DOUBLE THE PATIENT CENSUS IN THE HOUSE CALLS PRACTICE OVER A FOUR-YEAR PERIOD THROUGH REDESIGN OF THE SCHEDULED IN-HOME VISITS AND EVALUATION OF A HOME-BASED MONITORING TECHNOLOGY TO ENHANCE COMMUNICATION BETWEEN PATIENT AND PROVIDER. THE TEAM CONDUCTED INTERVIEWS AND FOCUS GROUPS WITH STAFF, PATIENTS AND CAREGIVERS TO IDENTIFY THEIR PERCEPTIONS OF THE HOUSE CALLS PROGRAM AND AREAS FOR IMPROVEMENT. IN 2018, THE INSTITUTE CONDUCTED PROCESS IMPROVEMENT ACTIVITIES WITHIN THE HOUSE CALLS PROGRAM THAT INCLUDED SHADOWING OF STAFF, IDENTIFICATION OF OPERATIONAL INEFFICIENCIES AND MITIGATION PLANS TO INCREASE CLINICAL WORKFLOW EFFICIENCIES. PROCESSES WERE IMPLEMENTED TO ENHANCE AND OPTIMIZE TRIAGE OF INCOMING PATIENT PHONE CALLS, ASSIGNMENT OF PATIENT ACUITY LEVELS, AND IMPROVE STANDARD OPERATING PROCEDURES FOR ACUTE VISITS. THE INSTITUTE ALSO WORKED TO IDENTIFY A TELEHEALTH SOLUTION IN 2018 AND CHOSE A VIDEO VISIT PLATFORM. 3. ADVANCING SUPPORTIVE SERVICES LONG-TERM SERVICES AND SUPPORTS (LTSS) ARE A FLEXIBLE ARRAY OF SOCIAL SUPPORT PROGRAMS AND SERVICES THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH (SDOH), ALLOWING SENIORS ACROSS THE COUNTRY TO REMAIN HEALTHY AND INDEPENDENT IN THEIR HOME FOR AS LONG AS POSSIBLE. IN THE U.S., CLINICAL CARE IS ESTIMATED TO ACCOUNT FOR APPROXIMATELY 20 PERCENT OF HEALTH OUTCOMES, WHILE THE OTHER 80 PERCENT OF HEALTH CONTRIBUTORS ARE SDOH. LTSS ADDRESS THE SDOH THROUGH COMMUNITY-BASED PROGRAMS THAT SUPPORT SENIORS' NUTRITIONAL NEEDS, ISOLATION, HOME ACCESSIBILITY, TRANSPORTATION, IN-HOME PERSONAL CARE AND HEALTH MANAGEMENT. EVEN THOUGH THE LARGEST DRIVERS OF HEALTHCARE COSTS FALL OUTSIDE OF THE CLINICAL SETTING, THE U.S. EXPENDS APPROXIMATELY 95 PERCENT OF THE TRILLIONS SPENT ON HEALTH CARE EACH YEAR ON CLINICAL SERVICES. FOR SENIOR MALNUTRITION ALONE, THE ANNUAL HEALTHCARE COSTS EXCEED $51 BILLON. DESPITE THE SIGNIFICANT IMPACT OF THE SDOH ON HEALTH OUTCOMES AND COSTS, LTSS IS UNDER-RESOURCED TO MEET THE INCREASING DEMANDS OF THE RAPIDLY GROWING SENIOR POPULATION, PARTICULARLY THOSE WITH MULTIPLE CHRONIC HEALTH CONDITIONS. LTSS ARE PRIMARILY FUNDED BY MEDICAID AND THE OLDER AMERICANS ACT, HOWEVER WITH RECENT POLICY CHANGES THERE ARE INCREASING OPPORTUNITIES FOR REIMBURSEMENT FOR MANY LTSS THROUGH MEDICAID MANAGED CARE, MEDICARE, MEDICARE ADVANTAGE AND ACOS. IN RECOGNITION OF THE INCREASED DEMAND BY HEALTHCARE ORGANIZATIONS TO ADDRESS THE SDOH, THE INSTITUTE IS RESEARCHING NEW WAYS FOR COMMUNITY-BASED AND HEALTHCARE ORGANIZATIONS TO DELIVER MORE COORDINATED, SENIOR-APPROPRIATE CARE BY SCREENING FOR AND ADDRESSING SDOH. MEALS ON WHEELS IN MARCH OF 2018, THE INSTITUTE, IN COLLABORATION WITH BROWN UNIVERSITY AND MEALS ON WHEELS AMERICA (MOWA), CONCLUDED A TWO-YEAR STUDY THAT DEVELOPED AND IMPLEMENTED A TECHNOLOGY-ENABLED CHANGE OF CONDITION MONITORING TOOL THAT ENHANCED MEAL DELIVERY PRACTICES, AND A CARE COORDINATION PROTOCOL TO IMPROVE THE HEALTH, SAFETY AND WELL-BEING OF VULNERABLE, HOME-BOUND, MEALS ON WHEELS (MOW) CLIENTS. IN 2018, CHANGE OF CONDITION MONITORING AND CARE COORDINATION SUPPORT WAS TESTED IN TWO MOW PROGRAMS, SAN DIEGO AND GUERNSEY, OHIO, AND INCLUDED A TOTAL OF 867 HOME-DELIVERED MEAL CLIENTS, 53 DRIVERS AND 21 ROUTES. OVER 20% OF THE CLIENTS WHO PARTICIPATED IN THE STUDY WERE IDENTIFIED BY DRIVERS AS HAVING AT LEAST ONE UNMET HEALTH OR SOCIAL NEED AND WERE REFERRED TO ASSISTANCE INCLUDING BUT NOT LIMITED TO HEALTH-RELATED SUPPORT, CARE MANAGEMENT, IN-HOME PERSONAL OR HOMEMAKER SERVICES, OR TRANSPORTATION. LEVERAGING LEARNINGS FROM THIS STUDY, IN JUNE 2018, MOWA AND THE INSTITUTE LAUNCHED A SECOND RESEARCH STUDY ENTITLED MORE THAN A MEAL PROCESS EXPANSION TO FURTHER TEST AND SCALE THE CLIENT CHANGE OF CONDITION AND CARE COORDINATION PROTOCOL ACROSS APPROXIMATELY 60 MOW PROGRAMS NATIONWIDE. IN ADDITION TO SCALING OF THIS INNOVATIVE MODEL, NEW ROBUST DATA TOOLS AND A NATIONAL DATA REPOSITORY WILL BE ESTABLISHED TO ORGANIZE, MONITOR AND REPORT KEY DATA AND PERFORMANCE METRICS. TRENDS IN CLIENT HEALTH, SAFETY AND WELL-BEING, AND CARE COORDINATION OUTCOMES WILL BE ATTAINABLE BY MOW PROGRAMS ALLOWING THEM TO ESTABLISH A BUSINESS CASE TO SECURE CONTRACTUAL PARTNERSHIPS WITH HEALTHCARE PROVIDERS AND THIRD-PARTY PAYERS TO SUPPORT THE HEALTH OF SENIORS THEY JOINTLY SERVE THROUGH THESE ENHANCED MEAL-DELIVERY SERVICES. UNIVERSITY OF CALIFORNIA, IRVINE IN COLLABORATION WITH THE UNIVERSITY OF CALIFORNIA, IRVINE (UCI), THE INSTITUTE IS ADVANCING PERSON-CENTERED CARE PRACTICES WITHIN AN ESTABLISHED SENIOR HEALTH CENTER BY EMBEDDING A CARE NAVIGATOR WITHIN THE CARE TEAM, SCREENING FOR UNMET SOCIAL NEEDS, AND UTILIZING A TECHNOLOGY PLATFORM TO LINK PATIENTS TO COMMUNITY-BASED SUPPORT SERVICES. PERSON-CENTERED CARE TRANSFORMS THE PATIENT EXPERIENCE FROM DISJOINTED CLINICAL AND COMMUNITY SERVICES TO A COMPREHENSIVE, SHARED PLAN THAT CONSIDERS ALL THE NEEDS OF THE PATIENT, AND COORDINATES THAT CARE ACROSS ALL SETTINGS AND PROVIDERS. IN 2018, UCI AND THE INSTITUTE DEVELOPED AND IMPLEMENTED A SOCIAL NEEDS SCREENER TO IDENTIFY PATIENTS AT-RISK FOR A POOR HEALTH OUTCOME OR UNNECESSARY, COSTLY HEALTHCARE UTILIZATION BECAUSE OF AN UNMET SOCIAL NEED. CARE NAVIGATION WORKFLOWS WERE ESTABLISHED TO FACILITATE THE IDENTIFICATION OF AND RESPONSE TO UNMET NEEDS. ADDITIONALLY, THE SOCIAL NEEDS SCREENER, FURTHER ASSESSMENTS, AND A SERVICE DIRECTORY WERE CONFIGURED WITHIN AN ELECTRONIC PLATFORM, CARESCOPE, TO FACILITATE REFERRALS TO COMMUNITY-BASED PROVIDERS AND TO SEND AND RECEIVE UPDATES ON THE PATIENT'S CHANGING HEALTH AND SOCIAL NEEDS. PATIENT ENROLLMENT AND BASELINE DATA COLLECTION BEGAN IN 2018 AND WILL CONTINUE THROUGH 2019. UNIVERSITY OF NORTH CAROLINA EMERGENCY DEPARTMENT MALNUTRITION AND MALNUTRITION RISK IS A GROWING PUBLIC HEALTH CRISIS NATIONWIDE WITH UP TO 50% OF SENIORS EITHER MALNOURISHED OR AT RISK FOR MALNUTRITION. THIS COMPLEX, MULTIFACETED CONDITION CONTRIBUTES TO POOR HEALTH, OVER $51B IN ANNUAL HEALTH-RELATED COSTS, AND PREMATURE DEATH. NUMEROUS HEALTH-RELATED AND SOCIAL RISK FACTORS ARE THE ROOT CAUSES OF MALNUTRITION. RECOGNIZING THE SIGNIFICANT IMPACT OF MALNUTRITION ON SUCCESSFUL AGING, THE INSTITUTE, IN COLLABORATION WITH THE UNIVERSITY OF NORTH CAROLINA HOSPITALS' ED IS ADVANCING MALNUTRITION CARE FOR SENIORS BY SCREENING FOR MALNUTRITION, MALNUTRITION RISK, AND FOOD INSECURITY IN A GED SETTING. THE TWO-YEAR STUDY, WHICH BEGAN IN OCTOBER 2018, WILL DEVELOP AND TEST A PROCESS TO SYSTEMATICALLY IDENTIFY OLDER PATIENTS WHO ARE AT-RISK FOR MALNUTRITION AND FOOD INSECURITY, AND LINK THEM TO COMMUNITY-BASED SOLUTIONS TO ADDRESS THE SOCIAL RISK FACTORS OF BOTH FOOD INSECURITY AND MALNUTRITION. SCREENING TOOLS WILL BE IDENTIFIED AND TESTED, AND A NEW SCREENING PROCESS FOR SENIOR PATIENTS AND WORKFLOW WILL BE ESTABLISHED AND INTEGRATED INTO UNC'S ELECTRONIC HEALTH RECORD. FORM 990, PART III, LINE 4A PATIENTS WHO SCREEN POSITIVE FOR BOTH MALNUTRITION RISK AND FOOD INSECURITY WILL BE LINKED TO A COMMUNITY-BASED ORGANIZATION (CBO) FOR ASSISTANCE. THE CBO WILL DETERMINE THE BEST APPROACH TO ADDRESS THE FOOD INSECURITY AND OTHER SOCIAL RISK CONTRIBUTING FACTORS, WHICH COULD INCLUDE POOR PHYSICAL, MENTAL AND DENTAL HEALTH, POVERTY, INSECURE HOUSING, LACK OF TRANSPORTATION, AND MOBILITY AND FUNCTIONAL LIMITATIONS. FORM 990, PART VI, SECTION A, LINE 2 ALMOST ALL OF THE CURRENT DIRECTORS AND OFFICERS HAVE A "BUSINESS RELATIONSHIP" AS DEFINED IN THE FORM 990 INSTRUCTIONS, WITH EACH OF THE OTHER CURRENT OFFICERS AND DIRECTORS BECAUSE OF POSITIONS THEY HOLD WITH AFFILIATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 3 GARY AND MARY WEST MANAGEMENT COMPANY, INC., A NON-PROFIT, TAXABLE ENTITY THAT PROVIDES SERVICES TO AFFILIATED ORGANIZATIONS CERTAIN SUPERVISORY, FINANCIAL AND OTHER ADMINISTRATIVE FUNCTIONS ARE PREFORMED BY EMPLOYEES OF GARY AND MARY WEST MANAGEMENT COMPANY, INC. TIMOTHY LASH, VALERIE VOLPE, DIANA CAMPAU, NANCY IVES SCHROEDER, WILLIAM EARLEY, SALLY HALLAK, JONATHAN ZIFFERBLATT (REFER TO SCHEDULE J). $2,155,009 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A NON-PROFIT, NON-STOCK CORPORATION WITH THREE MEMBERS DURING 2018. ONE INCORPORATED MEMBER DESIGNATED AS A PERMANENT MEMBER, THE GARY AND MARY WEST FOUNDATION, AND TWO NON-INCORPORATED MEMBERS WHICH ARE ELECTED AND TERM-BASED MEMBERS, WILLIAM PATRICK KRUER AND THOMAS CULHANE. ADDITIONALLY, MEMBERS APPOINT AND CAN REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION HAVE THE AUTHORITY TO ELECT AND REMOVE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING DECISIONS REQUIRE MEMBER APPROVAL: 1. THE DISSOLUTION, LIQUIDATION, MERGER, CONSOLIDATION, RECAPITALIZATION OR OTHER REORGANIZATION OF THE CORPORATION; 2. THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE CORPORATION; AND 3. ANY CHANGES PROPOSED TO BE MADE BY THE CORPORATION'S BOARD OF DIRECTORS TO THE CORPORATION'S CERTIFICATE OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 INFORMATION WAS COMPILED FROM THE ORGANIZATION'S CORPORATE AND ACCOUNTING RECORDS AND PROVIDED TO THE ORGANIZATION'S OUTSIDE TAX PREPARER. THE COMPLETED FORM 990 WAS REVIEWED BY THE ORGANIZATION'S VICE PRESIDENT OF FINANCE AND CONTROLLER, OUTSIDE LEGAL COUNSEL AND CEO. UPON SATISFACTORY COMPLETION OF THE INTERNAL REVIEW PROCESS, A DRAFT OF THE FORM 990 WAS CIRCULATED TO THE ORGANIZATION'S AUDIT COMMITTEE AND BOARD OF DIRECTORS FOR REVIEW. THE FORM 990 WAS THEN FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE DIRECTORS AND OFFICERS OF THE INSTITUTE MET REGULARLY THROUGHOUT 2018 AND DISCUSSED ALL ACTUAL AND POTENTIAL CONFLICTS OF INTEREST THAT EXISTED WITH RESPECT TO OTHER NON-PROFIT AND BUSINESS ORGANIZATIONS. THE DIRECTORS AND OFFICERS ALSO COLLECTED ANNUAL WRITTEN CONFLICT OF INTEREST STATEMENTS FROM ALL DIRECTORS AND OFFICERS. NO FAILURES OF COMPLIANCE WITH THE POLICY WERE FOUND. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS A COMPENSATION APPROVAL PROCESS FOR ITS EMPLOYEES. FOR THOSE PAID IN EXCESS OF $100,000, A BASIC COMPENSATION STUDY IS PERFORMED AND COMPENSATION RANGES ARE REQUIRED TO BE APPROVED BY THE BOARD OF DIRECTORS. FOR THOSE PAID IN EXCESS OF $250,000, SUCH AS THE CEO, AN ENHANCED STUDY OF COMPARABLE COMPENSATION IS PERFORMED AND THE BOARD OF DIRECTORS REVIEWS AND APPROVES COMPENSATION LEVELS. THE ORGANIZATION HAS ALSO RETAINED THE SERVICES OF AN OUTSIDE COMPENSATION CONSULTANT. THE MOST RECENT REVIEW WAS DONE IN EARLY 2016. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS CERTIFICATE OF INCORPORATION AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON THE REQUEST FOR SUCH DOCUMENTS. FORM 990, PART VII THE ORGANIZATION HAS A MANAGEMENT SERVICES AGREEMENT WITH THE GARY AND MARY WEST MANAGEMENT COMPANY, INC., A RELATED NON-PROFIT CORPORATION, WHEREBY THE GARY AND MARY WEST MANAGEMENT COMPANY, INC. PROVIDES CERTAIN ADMINISTRATIVE SUPPORT SERVICES TO THE ORGANIZATION. SUCH SERVICES INCLUDE THAT OF CHIEF ADMINISTRATION OFFICER AND GENERAL COUNSEL AND OTHER SENIOR MANAGEMENT ROLES. FORM 990, PART IX, LINE 11G CONSULTANTS: PROGRAM SERVICE EXPENSES 1,545,003. MANAGEMENT AND GENERAL EXPENSES 935,886. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,480,889. STUDIES/WHITEPAPERS/RESEARCH: PROGRAM SERVICE EXPENSES 10,299,934. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,299,934. STAKEHOLDER COMMUNICATIONS: PROGRAM SERVICE EXPENSES 226,100. MANAGEMENT AND GENERAL EXPENSES 925,692. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,151,792. OTHER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,019. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,019. FORM 990, PART XI, LINE 9: DONATED SERVICES -3,000. GARY AND MARY WEST HEALTH POLICY CENTER 1909 K STREET NW SUITE 730 WASHINGTON DC 20006 275388874 SEE SCH R, PART VII DE 501(C)(3) PF N/A 0 GARY AND MARY WEST HEALTH ENDOWMENT INC 1603 ORRINGTON AVE SUITE 810 EVANSTON IL 60201 272953865 FINANCIAL SUPPORT DE 501(C)(3) 11 N/A 0 REFLEXION HEALTH INC 225 BROADWAY SUITE 650 SAN DIEGO CA 92101 455417842 SEE SCH R, PART VII DE DIGITAL HEALTH CORP C 0 GARY AND MARY WEST MANAGEMENT COMPANY INC 5800 ARMADA DRIVE SUITE 100 CARLSBAD CA 92008 454040871 SEE SCH R, PART VII DE N/A C 0 DIGITAL HEALTH CORP 225 BROADWAY SUITE 300 SAN DIEGO CA 92101 820903337 SEE SCH R, PART VII DE GARY AND MARY WEST HEALTH ENDOWMENTINC C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 PART IV: IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A CORPORATION: NAME OF RELATED ORGANIZATION: DIGITAL HEALTH CORP. PRIMARY ACTIVITY: HEALTHCARE COMPANY THAT HARNESSES THE POWER OF THE LATEST TECHNOLOGY TO ACCELERATE AND IMPROVE PATIENT RECOVERY AT HOME. PART II: IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: GARY AND MARY WEST HEALTH POLICY CENTER, INC. PRIMARY ACTIVITY: POLICY RESEARCH TO DEVELOP MORE AFFORDABLE HEALTHCARE MODELS ENABLING SENIORS TO SUCCESSFULLY AGE. PART IV: IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A CORPORATION: NAME OF RELATED ORGANIZATION: REFLEXION HEALTH INC. PRIMARY ACTIVITY: DEVELOPING SOFTWARE TO BE USED BY PHYSICAL THERAPISTS AND PATIENTS IN PHYSICAL REHABILITATION TO LOWER THE COST OF HEALTH CARE. PART IV: IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A CORPORATION: NAME OF RELATED ORGANIZATION: GARY AND MARY WEST MANAGEMENT COMPANY, INC. TYPE OF ENTITY: GARY AND MARY WEST MANAGEMENT COMPANY, INC. IS A NON-STOCK, NON-PROFIT CORPORATION TAXED AS A C-CORPORATION THAT PROVIDES CERTAIN MANAGERIAL AND ADMINISTRATIVE SUPPORT SERVICES. PRIMARY ACTIVITY: PROVIDING MANAGEMENT AND ADMINISTRATIVE SUPPORT SERVICES.