2015-07-24T14:42:00-05:00 2014-12-31 521511275 RAFFA PC 1899 L STREET NW SUITE 900 WASHINGTON DC 20036 990 2014-01-01 200413676 HEALTHWELL FOUNDATION HEAL 2406325311 9801 WASHINGTONIAN BLVD 9TH FLOOR GAITHERSBURG MD 208785355 STEPHEN M WEINER BOARD CHAIR 2406325311 2015-07-24 1 FRANK H SMITH P00639053 2028225000 2015-07-20 2014 2016-02-25 16:41:14Z KRISTA ZODET 9801 WASHINGTONIAN BLVD 9TH FLOOR GAITHERSBURG MD 208785355 91646866 0 X WWW.HEALTHWELLFOUNDATION.ORG X 2003 DC HELP ELIGIBLE PATIENTS WITH CHRONIC OR LIFE-ALTERING CONDITIONS AFFORD THEIR MEDICAL TREATMENTS. 6 6 10 0 0 0 18482644 87271430 0 0 996272 1971876 0 0 19478916 89243306 31135498 29039150 0 0 1436451 1335417 200233 187931 357395 7673744 5993250 40445926 36555748 -20967010 52687558 41873758 95104829 3078978 2844066 38794780 92260763 X ASSIST UNDERINSURED PATIENTS LIVING WITH CHRONIC CONDITIONS WITH THEIR TREATMENT-RELATED COST-SHARING OBLIGATIONS. THE INDIVIDUALS ASSISTED BY THE FOUNDATION ARE AWARDED GRANTS ON A NONDISCRIMINATORY, OBJECTIVE AND FIRST-COME, FIRST-SERVED BASIS. THE FOUNDATION PROVIDES ASSISTANCE TO ELIGIBLE INDIVIDUALS ONLY FOR THE USE OF PRODUCTS THAT ARE APPROVED BY THE FOOD AND DRUG ADMINISTRATION, OR - IN SOME CASES - ARE COMPENDIA-LISTED FOR A SPECIFIC DISEASE INDICATION. 0 0 6033109 4790550 ASTHMA - ASSISTED 3,839 ELIGIBLE PATIENTS WITH DEDUCTIBLE, COINSURANCE, AND COPAYMENT EXPENSES RELATED TO THE TREATMENT OF ASTHMA. 5423555 3895276 IMMUNOSUPPRESSIVE TREATMENT FOR SOLID ORGAN TRANSPLANT RECIPIENTS - ASSISTED 4,107 ELIGIBLE PATIENTS WITH DEDUCTIBLE, COINSURANCE, COPAYMENT, OR PREMIUM EXPENSES ALLOWING THEM TO BEGIN OR CONTINUE IMMUNOSUPPRESSIVE THERAPY TO PREVENT REJECTION OF THE TRANSPLANTED ORGAN. 4629216 4218453 MULTIPLE SCLEROSIS - MEDICARE ACCESS - ASSISTED 1,520 ELIGIBLE PATIENTS WITH DEDUCTIBLE, COINSURANCE AND COPAYMENT EXPENSES RELATED TO THE TREATMENT OF MULTIPLE SCLEROSIS. 2897787 2649516 CYTOMEGALOVIRUS DISEASE 1984330 1863185 CHRONIC MYELOID LEUKEMIA - MEDICARE ACCESS 1981862 1732795 CARCINOID TUMORS AND ASSOCIATED SYMPTOMS - MEDICARE ACCESS 1890884 1608180 SYSTEMIC LUPUS ERYTHEMATOSUS 1809134 1570975 INFLAMMATORY BOWEL DISEASE - MEDICARE ACCESS 1309616 1080676 CHEMOTHERAPY - INDUCED NEUTROPENIA 1178641 1066869 GROWTH HORMONE DEFICIENCY 1161345 972066 HEAD AND NECK CANCER 924967 777706 SECONDARY HYPERPARATHYROIDISM 625494 518186 DUPUYTREN'S DISEASE 477862 399247 MELANOMA 381833 300956 URTICARIA 376822 338298 MELANOMA - MEDICARE ACCESS 329157 287959 AUTOIMMUNE - MEDICARE ACCESS 293589 222673 GOUT 263412 236432 ANCA - ASSOCIATED VASCULITIS, WEGENER'S AND GRANULOMATOSIS WITH POLYANGIITIS 239987 216335 PEYRONIE'S 86937 86937 PEDIATRIC 83379 55906 POST MENOPAUSAL OSTEOPOROSIS - MEDICARE ACCESS 67562 60415 NON-SMALL CELL LUNG CANCER 45071 40630 IRON OVERLOAD AS A RESULT OF BLOOD TRANSFUSIONS 42474 27609 BONE METASTASES 13466 10321 PORPHYRIAS 9266 2850 OTHER 8403 8149 BREAST CANCER 5704 0 ANEMIA ASSOCIATED WITH CHRONIC RENAL INSUFFICIENCY/FAILURE 1687 0 COLORECTAL CARCINOMA 18490671 16134871 34576551 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 22 0 1 10 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 9801 WASHINGTONIAN BLVD 9TH FLOOR GAITHERSBURG MD 208785355 STEPHEN M WEINER BOARD CHAIR 2.00 X X 0 0 0 JERRI SCARZELLA VICE CHAIR & TREASURER 1.00 X X 8000 0 0 NANCY CARTERON VICE CHAIR & SECRETARY 1.00 X X 8000 0 0 DAVID L KNOWLTON BOARD MEMBER 1.00 X 8000 0 0 DON LISS BOARD MEMBER 1.00 X 0 0 0 SUZANNE M MILLER BOARD MEMBER 1.00 X 8000 0 0 KRISTA ZODET PRESIDENT 40.00 X 204000 0 22521 SHELA HALPER DIR. OF STRATEGIC DEV. & MARKETING 40.00 X 176232 0 32156 BASKARAN VELLANDURAI DIRECTOR OF FINANCE & IT 40.00 X 171974 0 26915 584206 0 81592 3 0 1 1 COVANCE MARKET ACCESS 9801 WASHINGTONIAN BLVD 9TH FL GAITHERSBURG MD 20878 OPERATIONS OF PATIENT SERVICES 4221925 COVANCE SPECIALTY PHARMACY 500 EAGLES LANDING WAY LAKES LAND FL 33810 MANAGEMENT OF PHARMACY CARDS 295646 AB DATA GROUP 600 A B DATA DRIVE MILWAUKEE WI 53217 PROFESSIONAL FUNDRAISING 182011 WHITECOAT STRATEGIES LLC 1200 G STREET NW SUITE 800 WASHINGTON DC 20005 PUBLIC RELATIONS, COMMUNICATIONS 130610 ML STRATEGIES LLC 701 PENNSYLVANIA AVENUE NW WASHINGTON DC 20004 STRATEGIC PLANNING AND BUSINESS DEVELOPM 100012 5 87271430 87271430 1729915 1729915 2645521 2403560 241961 241961 241961 89243306 0 0 1971876 29039150 29039150 665798 85082 460664 120052 452819 165560 272503 14756 20315 8318 11151 846 127067 30807 95472 788 69418 16444 46780 6194 4142419 4142236 183 86515 86515 50244 50244 187931 187931 193920 193920 582032 350303 231729 26054 26054 522066 501505 16778 3783 115004 72645 42359 39899 10055 24718 5126 25582 23701 1881 15249 15249 759 759 177469 154446 23023 STATE REG. FEES 13119 13119 MEMBERSHIP DUES/SUBS. 2919 2919 36555748 34576551 1621802 357395 2133591 11463760 5871226 9897748 2360000 2350000 25102 25288 1141259 794490 396418 346769 30974112 70505126 1137 812 112172 515326 41873758 95104829 800623 1224538 1005000 0 1273355 1619528 3078978 2844066 X 4002497 5889433 34792283 86371330 38794780 92260763 41873758 95104829 52687558 778425 0 X 0 1 X 1 0 X 77404453 52749627 42379225 18482644 87271430 278287379 77404453 52749627 42379225 18482644 87271430 278287379 215560408 62726971 1195776 1419587 1617248 1397564 1729915 7360090 285647469 0.21960 0.19550 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 ASTHMA, CANCER AND IMMUNOSUPPRESSIVE DISORDERS. THROUGH 2014, THE FOUNDATION HAS HELPED OVER 200,000 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 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 AS OF DECEMBER 31, 2014 IS 21.96 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 & THE FOUNDATION'S COMMITMENT TO OPERATE AN OUTSTANDING ORGANIZATION THAT WILL ATTRACT FUTURE 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 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 10 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 23 CORPORATE DONORS.- IN ADDITION TO THE PRESIDENT AND DIRECTOR OF STRATEGIC DEVELOPMENT, THE FOUNDATION WORKS WITH A STRATEGIC PUBLIC RELATIONS FIRM AND A HEALTH CARE CONSULTING FIRM TO RESEARCH, IDENTIFY AND HELP PURSUE NEW CORPORATE FUNDRAISING OPPORTUNITIES.- THE FOUNDATION REGULARLY SOLICITS SUPPORT FROM PRIVATE INDIVIDUALS, WHICH HAS RESULTED IN DONATIONS FROM MORE THAN 10,000 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. THE BOARD ALSO RETAINS/ENGAGES AN ETHICAL ADVISOR TO OFFER ADDITIONAL PERSPECTIVE(S) IN THE EVOLVING HEALTHCARE DELIVERY SYSTEM.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 IS 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. 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, MARYLAND LUPUS SUMMIT 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, CAREMARK SPECIALTY PHARMACIES, NATIONAL MS SOCIETY, PSORIASIS FOUNDATION, LUPUS FOUNDATION OF AMERICA, CANCERCARE, PORPHYRIA FOUNDATION AND NEEDYMEDS, AMONG OTHERS.CONCLUSIONIN 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 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 129328 71377 57951 1011931 723113 288818 346769 CO-PAYMENTS AND PREMIUM ASSISTANCE PAYABLE 1619528 1619528 X 89827811 778425 778425 89049386 193920 193920 89243306 36361828 0 36361828 193920 193920 36555748 PART X, LINE 2: THE FOUNDATION PERFORMED AN EVALUATION OF UNCERTAIN TAX POSITIONS FOR THE YEAR ENDED DECEMBER 31, 2014, 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 268474 187931 80543 268474 187931 80543 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 ASTHMA 3839 4790550 MULTIPLE SCLEROSIS - MEDICARE ACCESS 1520 4218453 IMMUNOSUPPRESSIVE TREATMENT FOR SOLID ORGAN TRANSPLANT RECIPIENTS 4107 3895276 CYTOMEGALOVIRUS DISEASE 1544 2649516 CHRONIC MYELOID LEUKEMIA - MEDICARE ACCESS 361 1863185 CARCINOID TUMORS AND ASSOCIATED SYMPTOMS - MEDICARE ACCESS 569 1732795 SYSTEMIC LUPUS ERYTHEMATOSUS 513 1608180 INFLAMMATORY BOWEL DISEASE - MEDICARE ACCESS 830 1570975 CHEMOTHERAPY - INDUCED NEUTROPENIA 662 1080676 GROWTH HORMONE DEFICIENCY 487 1066869 HEAD AND NECK CANCER 449 972066 SECONDARY HYPERPARATHYROIDISM 904 777706 DUPUYTREN'S DISEASE 540 518186 MELANOMA 169 399247 MELANOMA - MEDICARE ACCESS 87 338298 URTICARIA 193 300956 AUTOIMMUNE - MEDICARE ACCESS 597 287959 ANCA - ASSOCIATED VASCULITIS, WEGENER'S AND GRANULOMATOSIS WITH POLYANGIITIS 77 236432 GOUT 172 222673 PEYRONIE'S 64 216335 PEDIATRIC 56 86937 NON-SMALL CELL LUNG CANCER 14 60415 POST MENOPAUSAL OSTEOPOROSIS - MEDICARE ACCESS 401 55906 IRON OVERLOAD AS A RESULT OF BLOOD TRANSFUSIONS 11 40630 BONE METASTASES 51 27609 PORPHYRIAS 5 10321 BREAST CANCER 1 8149 OTHER GRANTS 5 2850 PART I, LINE 2: EACH PATIENT SEEKING ASSISTANCE IS SCREENED FOR ELIGIBILITY EITHER BY A FOUNDATION REPRESENTATIVE 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 VIA THE STATEMENT OF TREATMENT FORM; AND TREATMENT MUST BE DISPENSED IN THE UNITED STATES. ONCE PATIENTS ARE PRE-QUALIFIED FOR A GRANT, THEY HAVE 30 DAYS DURING WHICH TIME THEY MUST SUBMIT TO THE FOUNDATION A COMPLETED AND SIGNED STATEMENT OF TREATMENT FORM AND ANY OTHER DOCUMENTATION DEEMED NECESSARY BY THE FOUNDATION. UNTIL THE FOUNDATION RECEIVES THESE DOCUMENTS, NO PAYMENTS WILL BE CONSIDERED OR REVIEWED FOR REIMBURSEMENT. UPON RECEIPT AND REVIEW OF THE DOCUMENTATION, IF IT IS DEEMED COMPLETE, THE PATIENT BECOMES FULLY APPROVED. 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 REPRESENTATIVE 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 REPRESENTATIVE PROCESSES THE PAYMENT. X X 0 0 0 0 0 0 0 1 0 KRISTA ZODET PRESIDENT 204000 0 0 0 0 0 12240 0 10281 0 226521 0 0 0 SHELA HALPER DIR. OF STRATEGIC DEV. & MARKETING 159307 0 16925 0 0 0 9558 0 22598 0 208388 0 0 0 BASKARAN VELLANDURAI DIRECTOR OF FINANCE & IT 155574 0 16400 0 0 0 9334 0 17581 0 198889 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, 2014, THE FOUNDATION PAID A TOTAL OF $30,105 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 DIRECTOR OF FINANCE 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 DISCLOSE TO A PATIENT OR A POTENTIAL PATIENT, UNDER ANY CIRCUMSTANCES, THE 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 AND ANNUAL REPORT ARE ALSO AVAILABLE AT WWW.HEALTHWELLFOUNDATION.ORG.