2016-08-02T02:46:33-05:00 2015-12-31 521511275 RAFFA PC 1899 L STREET NW SUITE 850 WASHINGTON DC 20036 990 2015-01-01 200413676 HEALTHWELL FOUNDATION HEAL 2406325311 20440 CENTURY BLVD NO 250 GERMANTOWN MD 20874 STEPHEN M WEINER BOARD CHAIR 2406325311 2016-08-02 1 FRANK H SMITH P00639053 2028225000 2016-07-13 2015 2016-12-15 16:53:06Z X KRISTA ZODET 20440 CENTURY BLVD NO 250 GERMANTOWN MD 20874 89781754 0 X WWW.HEALTHWELLFOUNDATION.ORG X 2003 DC HELP ELIGIBLE PATIENTS WITH CHRONIC OR LIFE-ALTERING CONDITIONS AFFORD THEIR MEDICAL TREATMENTS. 6 6 11 0 0 0 87271430 67134754 0 0 1971876 857232 0 0 89243306 67991986 29039150 57947101 0 0 1335417 1502884 187931 167022 469682 5993250 7846758 36555748 67463765 52687558 528221 95104829 93072651 2844066 4055751 92260763 89016900 X THE HEALTHWELL 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 ESSENTIAL MEDICAL TREATMENTS BECAUSE THEY CANNOT AFFORD THEM. 0 0 25171271 23330806 MULTIPLE SCLEROSIS - MEDICARE ACCESS - ASSISTED 9,513 ELIGIBLE PATIENTS WITH DEDUCTIBLE, COINSURANCE AND COPAYMENT EXPENSES RELATED TO THE TREATMENT OF MULTIPLE SCLEROSIS. 7474143 5581732 IMMUNOSUPPRESSIVE TREATMENT FOR SOLID ORGAN TRANSPLANT RECIPIENTS - ASSISTED 5,913 ELIGIBLE PATIENTS WITH DEDUCTIBLE, COINSURANCE, COPAYMENT, OR PREMIUM EXPENSES ALLOWING THEM TO BEGIN OR CONTINUE IMMUNOSUPPRESSIVE THERAPY TO PREVENT REJECTION OF THE TRANSPLANTED ORGAN. 4858911 4552169 CYTOMEGALOVIRUS DISEASE - PREVENTION AND TREATMENT- ASSISTED 2,325 ELIGIBLE PATIENTS WITH DEDUCTIBLE, COINSURANCE AND COPAYMENT EXPENSES RELATED TO THE PREVENTION OR TREATMENT CYTOMEGALOVIRUS DISEASE. 4145552 4101903 HEPATITIS C 3668343 2904183 ASTHMA 2858503 2687779 CHRONIC MYELOID LEUKEMIA- MEDICARE ACCESS 2710256 2368678 SYSTEMIC LUPUS ERYTHEMATOSUS 2046960 1808099 CARCINOID TUMORS AND ASSOCIATED SYMPTOMS - MEDICARE ACCESS 1554261 1425697 GROWTH HORMONE DEFICIENCY 1190791 964190 URTICARIA 1179171 987303 HEAD AND NECK CANCER 1044611 882198 NON-SMALL CELL LUNG CANCER 980625 773482 CHEMOTHERAPY-INDUCED NEUTROPENIA - MEDICARE ACCESS 790190 748446 PULMONARY FIBROSIS 762147 687302 INFLAMMATORY BOWEL DISEASE - MEDICARE ACCESS 636544 536643 SECONDARY HYPERPARATHYROIDISM 622003 615794 MELANOMA 586473 507814 DUPUYTREN'S DISEASE 540207 511998 NON-SMALL CELL LUNG CANCER - MEDICARE ACCESS 507964 467661 PEYRONIE'S DISEASE 496129 455787 ANCA - ASSOCIATED VASCULITIS, WEGENER'S AND GRANULOMATOSIS WITH POLYANGIITIS 467217 389836 CYSTIC FIBROSIS 452265 371994 GOUT 154396 139355 PEDIATRIC 142633 41398 MELANOMA - MEDICARE ACCESS 78601 65283 POST MENOPAUSAL OSTEOPOROSIS - MEDICARE ACCESS 23919 20641 PORPHYRIAS 14894 9480 OTHER 6444 6242 RENAL CELL CARCINOM - MEDICARE ACCESS 3411 3208 MULTIPLE MYELOMA 27664510 24482394 65168835 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 36 0 1 11 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 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 BASKARAN VELLANDURAI 2406325311 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 NANCY CARTERON MD FACR VICE CHAIR & SECRETARY 1.00 X X 12000 0 0 DAVID L KNOWLTON 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 235980 0 22690 SHELA HALPER DIR. OF STRATEGIC DEV. & MARKETING 40.00 X 184444 0 27828 BASKARAN VELLANDURAI DIRECTOR OF FINANCE & IT 40.00 X 180141 0 26755 648565 0 77273 3 0 1 1 COVANCE MARKET ACCESS SERVICES INC 9801 WASHINGTONIAN BLVD 9TH FL GAITHERSBURG MD 20878 HOTLINE SERVICES 6270966 COVANCE SPECIALTY PHARMACY 500 EAGLES LANDING WAY LAKES LAND FL 33810 MANAGEMENT OF PHARMACY CARDS 392528 AB DATA GROUP 600 A B DATA DRIVE MILWAUKEE WI 53217 PROFESSIONAL FUNDRAISING 157603 WHITECOAT STRATEGIES LLC 1200 G STREET NW SUITE 800 WASHINGTON DC 20005 PUBLIC RELATIONS, COMMUNICATIONS 121033 4 67134754 67134754 2004638 2004638 20642362 21789768 -1147406 -1147406 -1147406 67991986 0 0 857232 57947101 57947101 725838 103451 429765 192622 548958 200412 291679 56867 25210 11219 11115 2876 122490 30553 85126 6811 80388 20008 47613 12767 5660536 5660536 97681 97681 54060 54060 167022 167022 326872 326872 688015 450480 237535 26698 26698 507438 490712 12947 3779 126342 75398 50944 44832 10356 29197 5279 43110 43029 81 18333 18333 35042 35042 185823 166609 19214 6303 6303 STATE REG. FEES 13477 13477 MEMBERSHIP DUES/SUBS. 10101 2000 8101 TRAINING 2095 2095 67463765 65168835 1825248 469682 11463760 7036244 9897748 3482970 2350000 14800000 25288 41305 1253339 979988 346769 273351 70505126 67138744 201514 812 487 515326 98036 95104829 93072651 1224538 1747293 1619528 2308458 2844066 4055751 X 5889433 931502 86371330 88085398 92260763 89016900 95104829 93072651 X 528221 -3782541 10457 X 0 1 X 1 0 X 52749627 42379225 18482644 87271430 67134754 268017680 52749627 42379225 18482644 87271430 67134754 268017680 202200403 65817277 1419587 1617248 1397564 1729915 2004638 8168952 276186632 0.23830 0.21960 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, CANCER AND IMMUNOSUPPRESSIVE DISORDERS. THROUGH 2015, THE FOUNDATION HAS HELPED OVER 225,000 PATIENTS AFFORD THEIR PRESCRIPTION DRUG COPAYMENTS, PREMIUMS AND OTHER OUT-OF-POCKET HEALTH CARE COSTS.THE FOUNDATION PROVIDES GRANTS TO PATIENTS WHO HAVE PRIVATE OR GOVERNMENT-SPONSORED INSURANCE BUT WHO ARE STILL UNABLE TO AFFORD THEIR INSURANCE COPAYMENTS OR THE PREMIUMS TO OBTAIN COVERAGE FOR THEIR CONDITIONS. THE FOUNDATION MAKES ITS AWARDS BASED ON THE OBJECTIVE CONSIDERATION OF FINANCIAL AND MEDICAL CRITERIA AND THE ADEQUACY OF THE RECIPIENT'S INSURANCE COVERAGE. GRANTS ARE GIVEN TO RECIPIENTS FOR UP TO ONE YEAR AT A TIME. 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, 2015 IS 23.83%, 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 FOUNDATION'S PUBLIC SUPPORT PERCENTAGE HAS CONSISTENTLY INCREASED SINCE 2004; 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 HEALTHCARE 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 MANY DIFFERENT TYPES 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 HAS 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 11 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 29 CORPORATE DONORS.- THE FOUNDATION'S CHIEF BUSINESS 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 HELP PURSUE SPONSORS FOR THE FOUNDATION'S BROAD-BASED INITIATIVES, INCLUDING ITS PEDIATRIC ASSISTANCE FUND AND EMERGENCY CANCER RELIEF FUND, IN ADDITION TO IDENTIFYING AND DEVELOPING STRATEGIC ALLIANCES TO FURTHER PROMOTE AND FULFILL THE FOUNDATION'S MISSION.- THE FOUNDATION REGULARLY SOLICITS SUPPORT FROM PRIVATE INDIVIDUALS, WHICH HAS RESULTED IN DONATIONS FROM NEARLY 20,000 INDIVIDUAL DONORS. 2. REPRESENTATIVE GOVERNING BODY. THE 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 AND ADVOCATES CAN OBTAIN INFORMATION ON THE FOUNDATION'S PROGRAM, APPLY ON-LINE AND, THROUGH INTERACTIVE PORTALS, MANAGE A PATIENT'S PORTFOLIO OF GRANTS (PROVIDERS) OR MONITOR THEIR OWN GRANT (PATIENTS). THESE AVENUES ARE UPDATED CONTINUOUSLY AND MONITORED CLOSELY THROUGHOUT THE YEAR. WORKING WITH A STRATEGIC PR FIRM, 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, AND CBI PATIENT ADHERENCE & SUPPORT.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 HEALTHCARE 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 HEALTHCARE 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 30,000 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, 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 137470 86835 50635 1115869 893153 222716 273351 CO-PAYMENTS AND PREMIUM ASSISTANCE PAYABLE 2308458 2308458 X 63882573 -3782541 -3782541 67665114 326872 326872 67991986 67126436 0 67126436 326872 10457 337329 67463765 PART X, LINE 2: THE FOUNDATION PERFORMED AN EVALUATION OF UNCERTAIN TAX POSITIONS FOR THE YEAR ENDED DECEMBER 31, 2015, 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. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECOVERY OF PRIOR YEAR GRANTS 10,457. X X X 1 AB DATA GROUP 600 A B DATA DRIVE MILWAUKEE WI 53217 DIRECT MAIL CAMPAIGN 0 311154 167022 144132 311154 167022 144132 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 1 MULTIPLE SCLEROSIS - MEDICARE ACCESS 9513 23330806 IMMUNOSUPPRESSIVE TREATMENT FOR SOLID ORGAN TRANSPLANT RECIPIENTS 5913 5581732 CYTOMEGALOVIRUS DISEASE 2325 4552169 HEPATITIS C 427 4101903 ASTHMA 1994 2904183 CHRONIC MYELOID LEUKEMIA - MEDICARE ACCESS 514 2687779 SYSTEMIC LUPUS ERYTHEMATOSUS 707 2368678 CARCINOID TUMORS AND ASSOCIATED SYMPTOMS - MEDICARE ACCESS 737 1808099 GROWTH HORMONE DEFICIENCY 635 1425697 HEAD AND NECK CANCER 497 987303 URTICARIA 634 964190 NON-SMALL CELL LUNG CANCER 421 882198 CHEMOTHERAPY-INDUCED NEUTROPENIA - MEDICARE ACCESS 585 773482 PULMONARY FIBROSIS 328 748446 INFLAMMATORY BOWEL DISEASE - MEDICARE ACCESS 366 687302 MELANOMA 271 615794 SECONDARY HYPERPARATHYROIDISM 479 536643 NON-SMALL CELL LUNG CANCER 186 511998 DUPUYTREN'S DISEASE 550 507814 PEYRONIE'S DESEASE 174 467661 ANCA-ASSOCIATED VASCULITIS, WEGENER'S AND GRANULOMATOSIS WITH POLYANGIITIS 155 455787 CYSTIC FIBROSIS 601 389836 GOUT 196 371994 PEDIATRIC ASSISTANCE FUND 87 139355 POST-MENOPAUSAL OSTEOPOROSIS - MEDICARE ACCESS 207 65283 MELANOMA - MEDICARE ACCESS 17 41398 PORPHYRIAS 6 20641 HEALTH ACCESS 7 9480 RENAL CELL CARCINOMA 3 6242 MULTIPLE MYELOMA 1 3208 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. FOR SOME FUNDS, 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. FOR OTHER FUNDS, 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 0 0 0 0 0 0 0 1 0 KRISTA ZODET PRESIDENT 207650 0 28330 0 0 0 12240 0 10450 0 258670 0 0 0 SHELA HALPER DIR. OF STRATEGIC DEV. & MARKETING 168944 0 15500 0 0 0 10137 0 17691 0 212272 0 0 0 BASKARAN VELLANDURAI DIRECTOR OF FINANCE & IT 163741 0 16400 0 0 0 9824 0 16931 0 206896 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, 2015, THE FOUNDATION PAID A TOTAL OF $28,089 TO THE UNRELATED ORGANIZATION FOR THE TIME INCURRED BY MR. WEINER. FORM 990, PART VI, SECTION B, LINE 11 THE PRESIDENT, THE FOUNDATION'S DIRECTORS, AND THE SENIOR ACCOUNTANT REVIEW THE FEDERAL FORM 990 AND THEN FORWARD IT TO THE TREASURER FOR REVIEW. UPON COMPLETION OF REVIEW, 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 TRACING ALL FIGURES FROM AUDITED FINANCIAL STATEMENTS TO THE PREPARED FEDERAL FORM 990, AND REVIEWING ANY DISCREPANCIES WITH THE TAX PREPARERS. THE FOUNDATION'S FINANCE DEPARMENT 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 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 TO NOT REFER PATIENTS TO, OR RECOMMEND, A PARTICULAR PROVIDER, SUPPLIER, OR PRODUCT AND NOT TO IDENTITY OF 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. THIS MARKET ANALYSIS WAS FURTHER REVIEWED BY KORN-FERRY. THE LAST COMPENSATION REVIEW TOOK PLACE IN 2013 FOR THE PRESIDENT. 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, FOUNDATION FINANCIALS, AND ANNUAL REPORT ARE ALSO AVAILABLE AT WWW.HEALTHWELLFOUNDATION.ORG. FORM 990, PART XI, LINE 9: RECOVERY OF PRIOR YEAR GRANTS 10,457.