2018-06-22T07:05:42-05:00 2017-12-31 521511275 RAFFA PC 1899 L STREET NW SUITE 850 WASHINGTON DC 20036 990 2017-01-01 200413676 HEALTHWELL FOUNDATION HEAL 2406325305 20440 CENTURY BLVD NO 250 GERMANTOWN MD 20874 STEPHEN M WEINER BOARD CHAIR 2406325305 2018-06-22 1 FRANK H SMITH P00639053 2028225000 2018-06-22 2017 2022-09-23 18:48:47Z KRISTA ZODET 20440 CENTURY BLVD NO 250 GERMANTOWN MD 20874 382194885 0 X WWW.HEALTHWELLFOUNDATION.ORG X 2003 VA HELP ELIGIBLE PATIENTS WITH CHRONIC OR LIFE-ALTERING CONDITIONS AFFORD THEIR MEDICAL TREATMENTS. 6 6 14 0 0 0 139091107 350046179 0 0 2132239 3870987 0 0 141223346 353917166 102031281 236290414 0 0 1683269 1937260 206189 195325 579726 6192048 7381879 110112787 245804878 31110559 108112288 127590757 245686236 7513574 12244285 120077183 233441951 X THE HEALTHWELL FOUNDATION (THE FOUNDATION) REDUCES FINANCIAL BARRIERS TO CARE FOR UNDERINSURED PATIENTS WITH CHRONIC OR LIFE-ALTERING DISEASES. HEALTHWELL'S VISION IS TO ENSURE THAT NO PATIENT, ADULT, OR CHILD GOES WITHOUT MEDICAL TREATMENTS BECASUE THEY CANNOT AFFORD THEM. 0 0 56354451 55035980 MULTIPLE MYELOMA - MEDICARE ACCESS - PROVIDED COPAYMENT AND PREMIMUM ASSISTANCE TO 11,966 ELIGIBLE PATIENTS RECEIVING TREATMENT FOR MULTIPLE MYELOMA. 36950931 36391297 MULTIPLE SCLEROSIS - MEDICARE ACCESS - PROVIDED COPAYMENT AND PREMIMUM ASSISTANCE TO 8,989 ELIGIBLE PATIENTS RECEIVING TREATMENT FOR MULTIPLE SCLEROSIS. 30416564 30023796 PULMONARY FIBROSIS - PROVIDED COPAYMENT AND PREMIUM ASSISTANCE TO 7,467 ELIGIBLE PATIENTS BEING TREATED FOR PULMONARY FIBROSIS. 24313612 24219896 HEPATITIS C 18579046 17988044 SECONDARY HYPERPARATHYROIDISM 14602919 14143626 NON-SMALL CELL LUNG CANCER - MEDICARE ACCESS 11348993 10642315 BREAST CANCER - MEDICARE ACCESS 9648745 8955069 CYSTIC FIBROSIS 6718181 6423163 CHEMOTHERAPY-INDUCED NEUTROPENIA - MEDICARE ACCESS 5263340 4890410 BONE METASTASES - MEDICARE ACCESS 3323933 3121531 SYSTEMIC LUPUS ERYTHEMATOSUS 3024371 2899439 CARCINOID TUMORS AND ASSOCIATED SYMPTOMS - MEDICARE ACCESS 2562616 2361391 URTICARIA 2548027 2516467 CHRONIC MYELOID LEUKEMIA - MEDICARE ACCESS 2027560 1885916 CYSTIC FIBROSIS TREATMENTS 1512104 1398283 POST-MENOPAUSAL OSTEOPOROSIS - MEDICARE ACCESS 1272827 1207003 GOUT - MEDICARE ACCESS 1149310 1107536 PEYRONIE'S DISEASE 1046065 997896 DUPUYTREN'S DISEASE 1020917 980558 MELANOMA - MEDICARE ACCESS 860546 839579 ACUTE MYELOID LEUKEMIA - MEDICARE ACCESS 725310 710762 RENAL CELL CARCINOMA - MEDICARE ACCESS 647234 559164 IMMUNOSUPPRESSIVE TREATMENT FOR SOLID ORGAN TRANSPLANT RECIPIENTS - MEDICARE ACCESS 609037 586408 ANCA - ASSOCIATED VASCULITIS, WEGENER'S AND GRANULOMATOSIS WITH POLYANGIITIS 567273 437093 CYSTIC FIBROSIS VITAMINS AND SUPPLEMENTS 564206 524119 MACULAR DEGENERATION 562959 553213 MOVEMENT DISORDERS - MEDICARE ACCESS 527506 493808 DIABETIC FOOT ULCERS 499890 441774 PEDIATRIC ASSISTANCE 471184 440505 COLORECTAL CARCINOMA 454640 445272 GIANT CELL ARTERITIS OR TEMPORAL ARTERITIS - MEDICARE ACCESS 448633 437762 OVARIAN CANCER - MEDICARE ACCESS 403459 387633 INFLAMMATORY BOWEL DISEASE - MEDICARE ACCESS 345598 334377 AMYOTROPHIC LATERAL SCLEROSIS - MEDICARE ACCESS 334884 328907 BREAKTHROUGH CANCER PAIN - MEDICARE ACCESS 302375 287884 BLADDER AND UROTHELIAL CANCER - MEDICARE ACCESS 296800 291451 FUNGAL INFECTIONS - ASPERGILLOSIS AND CANDIDIASIS 226942 220920 CYTOMEGALOVIRUS DISEASE - PREVENTION AND TREATMENT 245730 222940 HEAD AND NECK CANCER - MEDICARE ACCESS 209000 205401 HUNTINGTON'S DISEASE - MEDICARE ACCESS 113948 107804 MELANOMA 88270 69452 CHEMOTHERAPY INDUCED NAUSEA OR VOMITING - MEDICARE ACCESS 86794 84629 GROWTH HORMONE DEFICIENCY 39651 38892 HIV AND AIDS WASTING SYNDROME AND ANOREXIA DUE TO HIV OR AIDS - MEDICARE ACCESS 29517 27204 PORPHYRIAS 13414 13086 HOMOCYSTINURIA 12956 10759 0THER 119650322 114839341 243372268 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 41 0 1 14 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 AL AK AZ AR CA CT FL GA HI IL KS KY LA ME MD MA MI MN MS NH NJ NM NY NC ND OH OK OR PA RI SC TN UT VT VA WA WV WI X X KRISTA ZODET 2406325305 20440 CENTURY BLVD STE 250 GERMANTOWN MD 20874 STEPHEN M WEINER BOARD CHAIR 2.00 X X 0 0 0 JERRI SCARZELLA BSN VICE CHAIR & TREASURER 1.00 X X 12000 0 0 DAVID L KNOWLTON VICE CHAIR & SECRETARY 1.00 X X 12000 0 0 NANCY CARTERON MD FACR BOARD MEMBER 1.00 X 12000 0 0 DON LISS MD BOARD MEMBER 1.00 X 0 0 0 SUZANNE M MILLER PHD BOARD MEMBER 1.00 X 12000 0 0 KRISTA ZODET PRESIDENT 40.00 X 241403 0 24192 ALAN KLEIN CHIEF DEVELOPMENT OFFICER 40.00 X 222032 0 20200 BASKARAN VELLANDURAI DIRECTOR OF FINANCE & IT 40.00 X 190002 0 25225 SHELA HALPER SR. DIRECTOR OF EXTERNAL RELATIONS 40.00 X 187972 0 27176 889409 0 96793 4 0 1 0 WRB COMMUNICATIONS INC 4200 LAFAYETTE CENTER DRIVE SUITE CHANTILLY VA 20151 HOTLINE SERVICES 4101530 MORGAN STANLEY 595 SOUTH FEDERAL HIGHWAY SUITE 40 BOCA RATON FL 33432 INVESTMENT MANAGEMENT 218392 BAKER DONELSON 901 K STREET NW WASHINGTON DC 20001 LEGAL SERVICES 198421 WHITECOAT STRATEGIES LLC 1200 G STREET NW SUITE 800 WASHINGTON DC 20005 PUBLIC RELATIONS 118603 4 350046179 350046179 3017353 3017353 29131353 28277719 853634 853634 853634 353917166 0 0 3870987 236290414 236290414 986202 230929 520667 234606 682501 343967 292772 45762 33140 14451 13623 5066 129274 50800 74483 3991 106143 36383 56830 12930 4737624 4737624 198300 75109 123191 64617 64617 195325 195325 252614 252614 628247 426249 185893 16105 177500 151882 10464 15154 331517 286374 45143 98981 37812 49940 11229 67082 33489 33593 52503 572 51721 210 33592 33592 103196 80219 22977 7048 7048 BAD DEBT EXPENSE 500000 500000 SUBS. AND LICENSES 113830 98066 11047 4717 OTHER EXPENSES 15228 11417 2773 1038 245804878 243372268 1852884 579726 9984733 70927326 29525554 2476670 20493088 11788334 56241 53192 1514780 1192414 334269 322366 66784952 159639247 203280 200558 162 208478 278543 127590757 245686236 3154252 6438139 4359322 5806146 7513574 12244285 X 355026 6451939 119722157 226990012 120077183 233441951 127590757 245686236 108112288 5252480 0 X 0 1 X 1 0 X 18482644 87271430 67134754 139091107 350046179 662026114 18482644 87271430 67134754 139091107 350046179 662026114 483034814 178991300 1397564 1729915 2004638 1866191 3017353 10015661 672041775 0.26630 0.26840 X THE HEALTHWELL FOUNDATION (THE "FOUNDATION") OFFERS THE FOLLOWING FACTS AND CIRCUMSTANCES IN SUPPORT OF ITS ONGOING CLASSIFICATION AS A PUBLIC CHARITY AND NOT A PRIVATE FOUNDATION.GENERAL BACKGROUND - THE FOUNDATION PROVIDES NEED-BASED FINANCIAL ASSISTANCE TO UNDERINSURED INDIVIDUALS LIVING WITH CHRONIC AND/OR LIFE-ALTERING ILLNESSES SUCH AS MULTIPLE SCLEROSIS, CYSTIC FIBROSIS, MULTIPLE MYELOMA AND MANY OTHER TYPES OF CANCER. THROUGH 2017, THE FOUNDATION HAS HELPED OVER 317,000 PATIENTS AFFORD THEIR PRESCRIPTION DRUG COPAYMENTS, PREMIUMS AND OTHER OUT-OF-POCKET HEALTH CARE COSTS.THE FOUNDATION GRANTS FUNDS TO PATIENTS WHO HAVE PRIVATE OR GOVERNMENT-SPONSORED INSURANCE BUT WHO ARE STILL UNABLE TO AFFORD THEIR INSURANCE COPAYMENTS OR PREMIUMS TO OBTAIN COVERAGE FOR THEIR CONDITIONS. THE FOUNDATION AWARDS GRANTS BASED ON THE OBJECTIVE CONSIDERATION OF FINANCIAL AND MEDICAL CRITERIA AND THE ADEQUACY OF THE RECIPIENT'S INSURANCE COVERAGE. GRANTS ARE AWARDED TO RECIPIENTS FOR A 12 MONTH CYCLE. THE FOUNDATION DOES NOT PLACE RESTRICTIONS ON THE MEDICATIONS ITS RECIPIENTS USE. THE DECISION AS TO WHICH MEDICATIONS ARE PRESCRIBED IS A MEDICAL JUDGMENT. FURTHER, THE FOUNDATION DOES NOT LIMIT THE PROVIDERS OR PHARMACIES ITS RECIPIENTS MAY USE TO OBTAIN THEIR MEDICATIONS.PUBLIC SUPPORT PERCENTAGE - THE FOUNDATION'S CUMULATIVE PUBLIC SUPPORT PERCENTAGE THROUGH DECEMBER 31, 2017 IS 26.63%, WHICH IS ABOVE THE MINIMUM AMOUNT AT WHICH FACTS AND CIRCUMSTANCES WILL BE CONSIDERED BY THE SERVICE IN DETERMINING THE FOUNDATION'S ONGOING QUALIFICATION AS A PUBLICLY SUPPORTED CHARITY. THE FACTS AND CIRCUMSTANCES RELATING TO THE FOUNDATION'S STRUCTURE AND OPERATIONS PRESENT AN EXCEPTIONALLY STRONG CASE IN SUPPORT OF ITS ONGOING CLASSIFICATION AS A PUBLIC CHARITY AND NOT AS A PRIVATE FOUNDATION. THESE FACTS AND CIRCUMSTANCES, WHICH ARE DISCUSSED IN MORE DETAIL LATER, INCLUDE THE FOLLOWING:1. THE FOUNDATION IS NOT CONTROLLED BY ITS CONTRIBUTORS AND HAS NO ENDOWMENT FUND, CHARACTERISTICS WHICH DISTINGUISH IT FROM VIRTUALLY ALL PRIVATE FOUNDATIONS.2. THE FOUNDATION'S BOARD REPRESENTS MANY DIVERSE ASPECTS OF THE HEALTH CARE COMMUNITY, DEMONSTRATING THE FOUNDATION'S COMMITMENT TO THE BROAD PUBLIC BENEFIT AND THE FOUNDATION'S COMMITMENT TO OPERATE AN OUTSTANDING ORGANIZATION THAT WILL ATTRACT FUTURE PUBLIC SUPPORT.3. THE FOUNDATION'S ACTIVITIES BROADLY BENEFIT THE GENERAL PUBLIC AS WELL AS OTHER CHARITABLE ORGANIZATIONS THAT ARE ATTEMPTING TO HELP PATIENTS COPE WITH A VARIETY OF ILLNESSES AND CONDITIONS.FACTS AND CIRCUMSTANCES SUPPORTING QUALIFICATION AS A PUBLICLY SUPPORTED ORGANIZATION1. ATTRACTION OF PUBLIC SUPPORT THE FOUNDATION'S POLICY IS TO ACCEPT CONTRIBUTIONS FROM DONORS AND TO DISBURSE THE CONTRIBUTIONS IN THE FORM OF GRANTS AS SOON AS PRACTICABLE. THE FOUNDATION DOES NOT HAVE AN ENDOWMENT FUND, AND ITS ABILITY TO FULFILL ITS FUTURE MISSION IS ENTIRELY DEPENDENT ON ITS ABILITY TO ATTRACT FUTURE SUPPORT FROM DONORS ON A CONTINUOUS BASIS. NONE OF THE FOUNDATION'S HISTORICAL SUBSTANTIAL CONTRIBUTORS HAVE PLEDGED OR OTHERWISE COMMITTED TO CONTINUE TO SUPPORT THE FOUNDATION IN FUTURE YEARS. THEREFORE, THE FOUNDATION MUST CONTINUALLY SEEK NEW DONORS TO SUSTAIN ITS FUNDS, AND IT HAS DONE SO. SPECIFICALLY:- THE FOUNDATION EMPLOYS 12 PERSONS WHO, IN ADDITION TO THEIR PRIMARY TASKS, MAY ALSO WORK ON FUNDRAISING PROJECTS AS NEEDED.- THE FOUNDATION'S CORPORATE CUMULATIVE DONOR BASE HAS INCREASED EACH YEAR FROM ONE CORPORATE DONOR IN 2004 TO 41 CORPORATE DONORS.- THE FOUNDATION'S CHIEF DEVELOPMENT OFFICER WORKS WITH THE PRESIDENT AND BOARD TO IDENTIFY AND PURSUE NEW CORPORATE FUNDRAISING OPPORTUNITIES.- THE FOUNDATION'S SENIOR DIRECTOR OF EXTERNAL RELATIONS WORKS TO IDENTIFY AND SECURE PARTNERS AND SPONSORS FOR THE FOUNDATION'S BROAD-BASED INITIATIVES, INCLUDING ITS PEDIATRIC ASSISTANCE FUND.- THE FOUNDATION REGULARLY SOLICITS SUPPORT FROM PRIVATE INDIVIDUALS, WHICH HAS RESULTED IN DONATIONS FROM MORE THAN 33,000 INDIVIDUAL DONORS. 2. REPRESENTATIVE GOVERNING BODYTHE FOUNDATION'S BOARD CONSISTS ENTIRELY OF NATIONALLY-RECOGNIZED HEALTH CARE EXPERTS WITH DEEP EXPERIENCE IN THE FIELDS OF HEALTH CARE ADMINISTRATION, CLINICAL PRACTICE AND RESEARCH, DIRECT PATIENT CARE, PATIENT ADVOCACY AND HEALTH LAW. THE COMPOSITION OF THE BOARD EXEMPLIFIES THE FOUNDATION'S COMMITMENT TO REPRESENT THE BROAD INTERESTS OF THE GENERAL PUBLIC AND TO OPERATE IN A MANNER THAT WILL ATTRACT ATTENTION - AND SUPPORT - FROM A BROAD RANGE OF POTENTIAL DONORS.GIVEN THEIR DIVERSE EXPERTISE, THE FOUNDATION'S BOARD MEMBERS BRING FORWARD A VARIETY OF IMPORTANT ISSUES TO ENCOURAGE DISCUSSION ABOUT HOW THE FOUNDATION'S PROGRAMS AND SERVICES WILL DIRECTLY IMPACT THE GENERAL PUBLIC. THEIR WIDE-RANGING OPINIONS HELP TO EXPAND THE FOUNDATION'S VIEWPOINT AND RESULT IN AN ORGANIZATION THAT CAN RESPOND SUCCESSFULLY TO IMPORTANT CHANGES IN THE HEALTH CARE ENVIRONMENT.SIGNIFICANTLY, NONE OF THE FOUNDATION'S BOARD MEMBERS ARE AFFILIATED WITH ANY CONTRIBUTOR TO THE FOUNDATION AND IT IS THE FOUNDATION'S STRICT POLICY THAT THERE NOT BE SUCH AFFILIATIONS. MOREOVER, NO CONTRIBUTOR HAS THE POWER TO APPOINT DIRECTORS TO THE FOUNDATION'S BOARD. IN THIS REGARD, THE FOUNDATION DIFFERS MARKEDLY FROM A PRIVATE FOUNDATION, WHERE THE GOVERNING BODY IS TYPICALLY COMPOSED OF SUBSTANTIAL CONTRIBUTORS AND/OR MEMBERS CHOSEN BY SUBSTANTIAL CONTRIBUTORS. 3. AVAILABILITY OF PUBLIC FACILITIES OR SERVICES; PUBLIC PARTICIPATION IN PROGRAMS OR POLICIES THE FOUNDATION PUTS FORTH SIGNIFICANT EFFORTS TO MAKE THE AVAILABILITY OF ITS PROGRAMS AND SERVICES KNOWN TO THE GENERAL PUBLIC THROUGH AVENUES SUCH AS ITS WEBSITE (WWW.HEALTHWELLFOUNDATION.ORG), WHERE PATIENTS, PROVIDERS, PHARMACIES AND ADVOCATES CAN OBTAIN INFORMATION ON THE FOUNDATION'S PROGRAM, APPLY ONLINE AND, THROUGH INTERACTIVE PORTALS, MANAGE A PATIENT'S PORTFOLIO OF GRANTS (PROVIDERS AND PHARMACIES) OR MONITOR THEIR OWN GRANT (PATIENTS). THESE AVENUES ARE UPDATED CONTINUOUSLY AND MONITORED CLOSELY THROUGHOUT THE YEAR. THE FOUNDATION ENGAGES IN A WIDE RANGE OF PROMOTIONAL OUTREACH ACTIVITIES, INCLUDING MEDIA RELATIONS AND BLOG ACTIVITIES (WWW.REALWORLDHEALTHCARE.ORG) IN ADDITION TO TARGETED SOCIAL MEDIA CAMPAIGNS TO EDUCATE THE PUBLIC, PROVIDERS, PHARMACIES AND OTHER HEALTH-RELATED ORGANIZATIONS ABOUT ITS WORK. NEWS ABOUT THE FOUNDATION'S PROGRAMS REGULARLY APPEARS IN LOCAL AND NATIONAL PUBLICATIONS, INCLUDING MEDICAL JOURNALS, NEWSPAPERS, RADIO SHOWS, MAGAZINES, BLOGS AND HEALTH CARE WEBSITES. REPRESENTATIVES OF THE FOUNDATION REGULARLY ATTEND NATIONAL AND LOCAL CONFERENCES TO PROMOTE THE FOUNDATION'S PROGRAMS, INCLUDING THOSE OF SUCH ENTITIES AS CBI PATIENT ASSISTANCE PROGRAM, THE LIVER MEETING, AMERICAN SOCIETY OF CLINICAL ONCOLOGY, NORTH AMERICAN CYSTIC FIBROSIS CONFERENCE, ASEMBIA SPECIALTY PHARMACY SUMMIT, CBI PATIENT ADHERENCE & SUPPORT, AMERICAN SOCIETY OF HEMATOLOGY, AND CBI PAP LEGAL UPDATE.ADDITIONALLY, WHEN THE FOUNDATION ESTABLISHES A NEW FUND WITH RESPECT TO A PARTICULAR DISEASE OR CONDITION, THE FOUNDATION:- IDENTIFIES KEY NATIONAL PATIENT ADVOCACY GROUPS AND HEALTH CARE ORGANIZATIONS THAT ARE ABLE TO REACH OUT TO PATIENTS IN THE NEW FUND AREA.- IDENTIFIES APPROPRIATE CONTACTS IN EACH ORGANIZATION THAT FOCUS ON PATIENT ADVOCACY AND/OR REIMBURSEMENT ISSUES. - INVITES THESE ORGANIZATIONS TO EDUCATE PATIENTS, PROVIDERS, ADVOCATES AND THEIR BROADER NETWORKS ABOUT THE FOUNDATION'S PROGRAMS BY POSTING A LINK TO WWW.HEALTHWELLFOUNDATION.ORG ON THEIR WEBSITES, PROMOTING VIA SOCIAL MEDIA AND/OR INCLUDING INFORMATION ABOUT THE FOUNDATION'S SERVICES IN THEIR MARKETING AND EDUCATIONAL MATERIALS. - ISSUES A PRESS RELEASE TO ANNOUNCE A NEW FUND TO THE MEDIA, PATIENT ADVOCACY GROUPS AND THE BROADER HEALTH CARE COMMUNITY.- REACHES OUT TO PROSPECTIVE DONORS TO SOLICIT ADDITIONAL SUPPORT FOR THE DISEASE AREA.- PROMOTES THE NEW FUND IN ITS NEWSLETTER, "THE PULSE," WHICH REACHES OVER 36,000 INDIVIDUALS FOUR TIMES A YEAR, AND THROUGH SOCIAL MEDIA.FURTHERMORE, THE FOUNDATION IS REFERENCED BY, OR IS LINKED TO, THE WEBSITES OF A NUMBER OF ORGANIZATIONS THAT DIRECT PATIENTS FOR COPAYMENT AND PREMIUM ASSISTANCE. SUCH ORGANIZATIONS INCLUDE PARTNERSHIP FOR PRESCRIPTION ASSISTANCE, AMERICAN CANCER SOCIETY, CMS, AMERICAN LIVER FOUNDATION, ALS FOUNDATION, NATIONAL MS SOCIETY, PSORIASIS FOUNDATION, LUPUS FOUNDATION OF AMERICA, CANCERCARE, AMERICAN PORPHYRIA FOUNDATION AND NEEDYMEDS, AMONG OTHERS. PART II, SECTION C, LINE 17A, FACTS AND CIRCUMSTANCES TEST: CONCLUSION IN SUMMARY, HEALTHWELL FOUNDATION HAS THE CHARACTERISTICS OF A "PUBLICLY SUPPORTED ORGANIZATION, BASED ON THE FACTS AND CIRCUMSTANCES TEST DESCRIBED IN SECTION 1.170A-9(E)(3) OF THE TREASURY REGULATIONS. SPECIFICALLY, A SMALL NUMBER OF DONORS DO NOT CONTROL HEALTHWELL; RATHER HEALTHWELL IS A GROWING INSTITUTION THAT BEARS MANY OF THE INDICIA OF A "PUBLICLY SUPPORTED ORGANIZATION, INCLUDING PUBLIC SUPPORT FROM A WIDE CROSS-SECTION OF DONORS WITH A REPRESENTATIVE GOVERNING BODY. MOREOVER, HEALTHWELL IS CONTINUING TO SEEK NEW SOURCES OF SUPPORT FROM THE GENERAL PUBLIC AS WELL AS OTHER ORGANIZATIONS. ACCORDINGLY, THE FOUNDATION QUALIFIES AS A "PUBLICLY SUPPORTED ORGANIZATION DESCRIBED IN SECTION 170(B)(1)(A)(VI). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 137689 113363 24326 1377091 1079051 298040 322366 COPAYMENTS AND PREMIUM ASSISTANCE PAYABLE 5764371 DEFERRED RENT 41775 5806146 X 358917032 5252480 5252480 353664552 252614 252614 353917166 245552264 0 245552264 252614 252614 245804878 PART X, LINE 2: THE FOUNDATION PERFORMED AN EVALUATION OF UNCERTAIN TAX POSITIONS FOR THE YEAR ENDED DECEMBER 31, 2017, AND DETERMINED THAT THERE WERE NO MATTERS THAT WOULD REQUIRE RECOGNITION IN THE FINANCIAL STATEMENTS OR THAT MAY HAVE ANY EFFECT ON ITS TAX-EXEMPT STATUS. X X X 1 AB DATA GROUP 600 A B DATA DRIVE MILWAUKEE WI 53217 DIRECT MAIL CAMPAIGN 0 482795 195325 287470 482795 195325 287470 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY DC SCHEDULE G, PART I, LINE 2B, COLUMN (V) THE FOUNDATION PAID IN TOTAL $159,574 TO A.B. DATA GROUP OF WHICH, $74,180 WAS FOR EXPENSE REIMBURSEMENTS. 1 MULTIPLE MYELOMA - MEDICARE ACCESS 11966 55035980 MULTIPLE SCLEROSIS - MEDICARE ACCESS 8989 36391297 PULMONARY FIBROSIS 7467 30023796 HEPATITIS C 3051 24219896 SECONDARY HYPERPARATHYROIDISM 13183 17988044 NON-SMALL CELL LUNG CANCER - MEDICARE ACCESS 4711 14143626 BREAST CANCER - MEDICARE ACCESS 2731 10642315 CYSTIC FIBROSIS 5334 8955069 CHEMOTHERAPY-INDUCED NEUTROPENIA - MEDICARE ACCESS 3638 6423163 BONE METASTASES - MEDICARE ACCESS 3979 4890410 SYSTEMIC LUPUS ERYTHEMATOSUS 981 3121531 CARCINOID TUMORS AND ASSOCIATED SYMPTOMS - MEDICARE ACCESS 1269 2899439 CHRONIC MYELOID LEUKEMIA - MEDICARE ACCESS 418 2516467 URTICARIA 1275 2361391 CYSTIC FIBROSIS TREATMENTS 2377 1885916 POST-MENOPAUSAL OSTEOPOROSIS - MEDICARE ACCESS 4241 1398283 GOUT 489 1207003 PEYRONIE'S DISEASE 453 1107536 DUPUYTREN'S DISEASE 851 997896 MELANOMA - MEDICARE ACCESS 192 980558 ACUTE MYELOID LEUKEMIA - MEDICARE ACCESS 262 839579 RENAL CELL CARCINOMA - MEDICARE ACCESS 300 710762 ANCA - ASSOCIATED VASCULITIS, WEGENER'S AND GRANULOMATOSIS WITH POLYANGIITIS 232 586408 IMMUNOSUPPRESSIVE TREATMENT FOR SOLID ORGAN TRANSPLANT RECIPIENTS - MEDICARE ACCESS 942 559164 MOVEMENT DISORDERS - MEDICARE ACCESS 231 553213 MACULAR DEGENERATION 640 524119 DIABETIC FOOT ULCERS 959 493808 GIANT CELL ARTERITIS OR TEMPORAL ARTERITIS - MEDICARE ACCESS 240 445272 PEDIATRIC ASSISTANCE 299 441774 COLORECTAL CARCINOMA 279 440505 OVARIAN CANCER - MEDICARE ACCESS 215 437762 CYSTIC FIBROSIS VITAMINS AND SUPPLEMENTS 2101 437093 INFLAMMATORY BOWEL DISEASE - MEDICARE ACCESS 307 387633 AMYOTROPHIC LATERAL SCLEROSIS - MEDICARE ACCESS 141 334377 BREAKTHROUGH CANCER PAIN - MEDICARE ACCESS 161 328907 FUNGAL INFECTIONS - ASPERGILLOSIS AND CANDIDIASIS 179 291451 BLADDER AND UROTHELIAL CANCER - MEDICARE ACCESS 179 287884 HEAD AND NECK CANCER - MEDICARE ACCESS 147 222940 CYTOMEGALOVIRUS DISEASE - PREVENTION AND TREATMENT 172 220920 HUNTINGTON'S DISEASE - MEDICARE ACCESS 84 205401 MELANOMA 56 107804 GROWTH HORMONE DEFICIENCY 64 84629 CHEMOTHERAPY INDUCED NAUSEA OR VOMITING - MEDICARE ACCESS 171 69452 HIV AND AIDS WASTING SYNDROME AND ANOREXIA DUE TO HIV OR AIDS - MEDICARE ACCESS 14 38892 PORPHYRIAS 8 27204 HOMOCYSTINURIA 7 13086 OTHER 16 10759 PART I, LINE 2: EACH PATIENT SEEKING ASSISTANCE IS SCREENED FOR ELIGIBILITY EITHER BY A SPECIALIST THROUGH THE FOUNDATION HOTLINE OR THROUGH THE FOUNDATION'S ONLINE APPLICATION TOOL. CRITERIA ARE STATIC ACROSS ALL THE FOUNDATION FUNDS: THE PATIENT'S HOUSEHOLD INCOME MAY BE UP TO 500% OF THE FEDERAL POVERTY LIMIT, ADJUSTED FOR HOUSEHOLD SIZE AND HIGH COST OF LIVING AREAS; THE PATIENT MUST HAVE A DIAGNOSIS THAT THE FOUNDATION CURRENTLY SUPPORTS; THE PATIENT MUST HAVE INSURANCE COVERAGE FOR THE TREATMENT FOR WHICH THEY ARE SEEKING ASSISTANCE AND THAT TREATMENT MUST BE AN ELIGIBLE TREATMENT UNDER THE HEALTHWELL FUND; THE PATIENT'S PHYSICIAN, NURSE PRACTITIONER OR PHYSICIAN'S ASSISTANT MUST VERIFY THE PATIENT'S DIAGNOSIS; AND TREATMENT MUST BE DISPENSED IN THE UNITED STATES. PATIENTS ARE APPROVED IF ALL CRITERIA ARE MET DURING SCREENING. PATIENTS RECEIVE A PHARMACY CARD TO USE AT THE LOCAL RETAIL PHARMACY, THROUGH MAIL ORDER PHARMACY, OR THROUGH SPECIALTY PHARMACY. THE PHARMACY CARD CANNOT BE USED FOR PRIMARY PAYMENT AND PROVIDES ELECTRONIC POINT OF SALE REIMBURSEMENT FOR THE PHARMACY. IN CASES WHERE THE PHARMACY CARD CANNOT BE USED, THE FOUNDATION REQUIRES THE SUBMISSION OF A COMPLETED REIMBURSEMENT REQUEST FORM ALONG WITH ADDITIONAL INFORMATION AS OUTLINED ON THE FORM. UPON RECEIPT, THE REQUEST IS REVIEWED: A FOUNDATION PAYMENT SPECIALIST ENTERS THE RECEIVED INFORMATION INTO THE SYSTEM AND THE SYSTEM VALIDATES THE DATE OF SERVICE, AN INSURER PAID FIRST, THE PRODUCT IS AN ELIGIBLE TREATMENT UNDER THE HEALTHWELL FUND, AND THE PATIENT HAS AN ACTIVE, FULLY APPROVED GRANT. ONLY IF ALL SYSTEMATIC CHECKS PASS, THE PAYMENT SPECIALIST PROCESS THE PAYMENT. X X X X X 0 0 0 0 0 0 0 1 0 KRISTA ZODET PRESIDENT 209885 0 31518 0 0 0 12593 0 11599 0 265595 0 0 0 ALAN KLEIN CHIEF DEVELOPMENT OFFICER 170649 0 51383 0 0 0 10239 0 9961 0 242232 0 0 0 BASKARAN VELLANDURAI DIRECTOR OF FINANCE & IT 166365 0 23637 0 0 0 9982 0 15243 0 215227 0 0 0 SHELA HALPER SR. DIRECTOR OF EXTERNAL RELATIONS 170878 0 17094 0 0 0 10253 0 16923 0 215148 0 0 0 PART I, LINE 7 ALL BONUS PAYMENTS RECEIVED BY OFFICERS AND KEY EMPLOYEES LISTED IN FORM 990, PART VII ARE BASED ON AN APPRAISAL OF HIS/HER PERFORMANCE. FORM 990, PART VII, LINE 5: THE BOARD CHAIR OF THE FOUNDATION, STEPHEN WEINER, IS ALSO A PARTNER AT MINTZ, LEVIN, COHN, FERRIS, GLOVSKY, AND POPEO, PC, AN UNRELATED ORGANIZATION. FOR THE YEAR ENDED DECEMBER 31, 2017, THE FOUNDATION PAID A TOTAL OF $29,288 TO THE UNRELATED ORGANIZATION FOR THE TIME INCURRED BY MR. WEINER. FORM 990, PART VI, SECTION A, LINE 4 IN SEPTEMBER 2017, THE BOARD OF DIRECTORS APPROVED CHANGES TO THE FOUNDATION'S BYLAWS RELATED TO ITS RE-DOMESTICATION TO THE COMMONWEALTH OF VIRGINIA. THESE CHANGES WERE MADE IN ORDER TO CONFORM THE FOUNDATION'S BYLAWS TO THE REQUIREMENTS OF APPLICABLE VIRGINIA NON-PROFIT CORPORATION LAW. FORM 990, PART VI, SECTION B, LINE 11B THE PRESIDENT, THE FOUNDATION'S DIRECTORS, AND THE SENIOR ACCOUNTANT REVIEWS THE FEDERAL FORM 990 AND THEN FORWARD IT TO THE TREASURER. UPON COMPLETION OF THE INTERNAL REVIEWS, THE PRESIDENT AUTHORIZES THE FEDERAL FORM 990 BE E-FILED AND THEN RETURNS THE FEDERAL FORM 990 TO THE DIRECTOR OF FINANCE. REVIEW CONSISTS OF TRACKING ALL FIGURES FROM AUDITED FINANCIAL STATEMENTS TO THE PREPARED FEDERAL FORM 990, AND REVIEWING ANY DISCREPANCIES WITH THE TAX PREPARERS. THE FOUNDATION'S FINANCE DEPARTMENT PROVIDES EACH BOARD MEMBER A COPY FOR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION'S PRESIDENT AND THE BOARD COMPLIANCE OFFICER WORK TOGETHER TO ENSURE ADHERENCE TO THE FOUNDATION'S COMPLIANCE PROGRAM. INCLUDED IN THIS COMPLIANCE PROGRAM ARE: STAFF AND BOARD OF DIRECTORS FOLLOW A CODE OF CONDUCT; STAFF MUST SIGN A CONFIDENTIALITY AND CONFLICT OF INTEREST AGREEMENT UPON HIRE; MEMBERS OF THE BOARD OF DIRECTORS AND SENIOR STAFF MUST SIGN A CONFLICT OF INTEREST DISCLOSURE ANNUALLY (MEMBERS THAT ARE DEEMED TO HAVE A CONFLICT OF INTEREST BASED ON THIS DISCLOSURE ARE RECUSED FROM PARTICIPATING IN A VOTE WITHIN THAT AREA OF CONFLICT); AND EXECUTIVE STAFF AND BOARD ALSO ATTEST TO UNDERSTANDING AND ADHERING TO THE POLICY AND PRACTICE OF THE HEALTHWELL FOUNDATION. THE EXECUTIVE STAFF AND BOARD CANNOT REFER PATIENTS TO, OR RECOMMEND A PARTICULAR PROVIDER, SUPPLIER, OR PRODUCT NOR THE IDENTITY ANY PROGRAM DONOR. FORM 990, PART VI, SECTION B, LINE 15 GUIDESTAR NONPROFIT EXECUTIVE COMPENSATION MARKET ANALYSIS DATA WAS USED TO DETERMINE COMPENSATION FOR THE PRESIDENT AND DIRECTORS. HEALTHWELL WILL BE CONDUCTING A COMPENSATION REVIEW IN 2018 WHILE THE LAST ONE TOOK PLACE IN 2016. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND THE FEDERAL FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FEDERAL FORM 990, THE FOUNDATION'S FINANCIALS, AND ANNUAL REPORT ARE ALSO AVAILABLE AT WWW.HEALTHWELLFOUNDATION.ORG.