2012-08-13T15:03:08-05:00 2011-12-31 521511275 RAFFA PC 1899 L STREET NW SUITE 900 WASHINGTON DC 20036 990 2011-01-01 200413676 HEALTHWELL FOUNDATION HEAL 2406325311 9801 WASHINGTONIAN BLVD 9TH FLOOR GAITHERSBURG MD 208785355 MARY SUNDEEN 2406325311 2012-08-13 1 FRANK H SMITH P00639053 2028225000 2012-08-13 2011 2016-02-24 21:20:13Z MARY P SUNDEEN 9801 WASHINGTONIAN BLVD 9TH FLOOR GAITHERSBURG MD 208785355 63537188 0 X WWW.HEALTHWELLFOUNDATION.ORG X 2003 DC ADDRESSING THE NEEDS OF PEOPLE WITH INSURANCE WHO CANNOT AFFORD NECESSARY MEDICATIONS. 6 6 9 0 0 0 77404453 52749627 0 0 1195776 1092568 0 0 78600229 53842195 84233714 49521777 0 0 1044019 1200720 203238 186388 332738 14823574 14609716 100304545 65518601 -21704316 -11676406 87086973 66318603 35480778 4719259 51606195 61599344 X ASSIST INCOME ELIGIBLE INSURED INDIVIDUALS IN OBTAINING NECESSARY MEDICATIONS. 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 ARE COMPENDIA-LISTED FOR A SPECIFIC DISEASE INDICATION. 0 1 13984808 10147619 AUTOIMMUNE FUND - ASSISTED 8,180 ELIGIBLE MEDICARE BENEFICIARIES WITH DEDUCTIBLE, COINSURANCE, AND COPAYMENT EXPENSES RELATED TO THE TREATMENT OF RHEUMATOID ARTHRITIS, PSORIASIS, PSORIATIC ARTHRITIS, AND ANKYLOSING SPONDYLITIS. 8663613 5849760 SECONDARY HYPERPARATHYROIDISM (SHPT) FUND - ASSISTED 6,103 ELIGIBLE PATIENTS WITH DEDUCTIBLE AND COINSURANCE, COPAYMENT, OR PREMIUM OUT OF POCKET EXPENSES ENABLING THEM TO ACCESS TREATMENT FOR SHPT. 6594147 6761361 RHEUMATOID ARTHRITIS FUND - ASSISTED 2,442 ELIGIBLE PATIENTS WITH DEDUCTIBLE AND COINSURANCE, COPAYMENT, OR PREMIUM EXPENSES ALLOWING THEM TO BEGIN OR CONTINUE TREATMENT OF MODERATELY TO SEVERELY ACTIVE RHEUMATOID ARTHRITIS. 5825208 4291029 CHEMOTHERAPY-INDUCED NEUTROPENIA 4285202 2684504 COLORECTAL CARCINOMA 4059618 3235543 ASTHMA, MODERATE TO SEVERE 3306256 2159275 ANEMIA ASSOCIATED WITH CHRONIC RENAL INSUFFICIENCY/FAILURE 2796697 1782836 IMMUNOSUPPRESSIVE THERAPY 2140284 2383657 BREAST CANCER 1653963 1800263 NON-HODGKIN'S LYMPHOMA 1507072 1627730 PSORIASIS 1244166 939297 AGE-RELATED MACULAR DEGENERATION 870327 551225 HEAD AND NECK CANCER 786509 895812 PSORIATIC ARTHRITIS 665199 250022 CHEMOTHERAPY-INDUCED ANEMIA/NEUTROPENIA 623669 373393 CROHN'S DISEASE 616780 587902 CARCINOID TUMORS 517179 318058 OSTEOPOROSIS 494614 403937 BONE METASTASES 475167 340403 CHRONIC MYELOID LEUKEMIA 413278 341083 METASTIC MELANOMA 382011 315931 IDIOPATHIC THROMBOCYTOPENIC PURPURA 328376 87726 LUPUS 299478 339580 ANKYLOSING SPONDYLITIS 219002 334559 IRON OVERLOAD DUE TO MULTIPLE TRANSFUSIONS 194988 251581 CHEMOTHERAPY-INDUCED ANEMIA 182404 11061 CHRONIC MYELOID LEUKEMIA - MEDICARE ACCESS 148874 88443 HEPATITIS 133759 99529 DUPUYTREN'S DISEASE 129122 49949 GOUT 126680 30420 ASSOCIATED VASCULITIS AND WEGENERS 116432 75182 NON-SMALL CELL LUNG CANCER 40710 31458 CYTOMEGALOVIRUS 32377 32377 SPECIAL DONATIONS 15498 49272 OTHER 34630899 26763037 63873467 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 0 1 12 0 1 9 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 WEINER 2.00 X X 0 0 0 JERRI SCARZELLA 1.00 X X 9000 0 0 NANCY CARTERON 1.00 X X 9000 0 0 DAVID KNOWLTON 1.00 X 9000 0 0 DON LISS 1.00 X 0 0 0 SUZANNE MILLER 1.00 X 6000 0 0 MARY P SUNDEEN 40.00 X 272837 0 41714 SHELA HALPER 40.00 X 165748 0 20097 BASKARAN VELLANDURAI 40.00 X 163941 0 20210 KRISTA ZODET 32.00 X 140279 0 15349 775805 0 97370 4 0 1 1 COVANCE MARKET ACCESS 9801 WASHINGTONIAN BLVD 9TH FL GAITHERSBURG MD 20878 OPERATIONS OF PATIENT SERVICES 12675869 ACCOUNTING SEED LLC 4717 WIGGLESWORTH CT ELLICOTT CITY MD 21043 SYSTEM DEVELOPMENT 444823 COVANCE SPECIALTY PHARMACY 500 EAGLES LANDING WAY LAKES LAND FL 33810 MANAGEMENT OF PHARMACY CARDS 429863 TRIAL CARD 6501 WESTON PKWY 370 CARY NC 27513 MANAGEMENT OF PHARMACY CARDS 341868 AB DATA GROUP 600 A B DATA DRIVE MILWAUKEE WI 53217 PROFESSIONAL FUNDRAISING 186388 6 52749627 52749627 1419587 1419587 9367974 9694993 -327019 -327019 -327019 53842195 0 0 1092568 49521777 49521777 706547 243852 366194 96501 334678 106347 212681 15650 13893 2793 10256 844 84359 26224 50438 7697 61243 19710 34388 7145 11329502 11329502 186733 112040 74693 62773 62773 186388 186388 133275 133275 1119284 874993 231703 12588 30321 30321 1407725 1359588 42725 5412 126351 99766 26585 36528 36528 26681 4917 21251 513 5740 5740 137287 109185 28102 3009 3009 STATE REG. FEES 3859 3859 TRAINING 648 648 65518601 63873467 1312396 332738 76996 45599 47663707 17360043 2000000 798309 329810 109863 468499 36059719 48247233 1176688 197229 87086973 66318603 1363916 2171355 34116862 2547904 35480778 4719259 X 2152091 3381943 49454104 58217401 51606195 61599344 87086973 66318603 X -11676406 21669555 X 0 1 1 X 0 X 56218602 62065378 67538322 77404453 52749627 315976382 56218602 62065378 67538322 77404453 52749627 315976382 262861413 53114969 4608767 3529018 2102642 1195776 1419587 12855790 2373 2373 328834545 0.16150 0.12250 X 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-THREATENING ILLNESSES SUCH AS ASTHMA, CANCER AND AUTOIMMUNE DISORDERS. THROUGH 2011, THE FOUNDATION HAS HELPED ABOUT 152,000 PATIENTS AFFORD THEIR PRESCRIPTION DRUG CO-PAYMENTS, 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 CO-PAYMENTS OR THE PREMIUMS TO CONTINUE 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 ONE YEAR. THE FOUNDATION ONLY COVERS FDA-APPROVED OR COMPENDIA-LISTED MEDICATIONS. 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, 2011 IS AT 16.15%, WHICH IS THE 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. NOTWITHSTANDING THIS RELATIVELY LOW PERCENTAGE, 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 OF DIRECTORS 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 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 NINE PERSONS WHO, IN ADDITION TO THEIR PRIMARY TASKS, MAY ALSO WORK ON FUNDRAISING PROJECTS AS NEEDED.THE FOUNDATION'S CORPORATE DONOR BASE HAS INCREASED FROM ONE CORPORATE DONOR IN 2004 TO THIRTEEN CORPORATE DONORS IN 2011.IN ADDITION TO THE DIRECTOR OF DEVELOPMENT, THE FOUNDATION WORKS WITH A DEVELOPMENT CONSULTING FIRM TO RESEARCH, IDENTIFY AND HELP PURSUE NEW FUNDRAISING OPPORTUNITIES.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 EXPERIENCES, 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 CAN APPLY ON-LINE FOR ASSISTANCE, FREE MEDIA, CONFERENCES AND OUTREACH TO THOUGHT LEADERS. THESE AVENUES ARE UPDATED CONTINUOUSLY AND MONITORED CLOSELY THROUGHOUT THE YEAR. THROUGH THE EFFORTS OF INTERNAL STAFF, AS WELL AS A DEVELOPMENT CONSULTING FIRM, NEWS ABOUT THE FOUNDATION'S PROGRAMS APPEARS IN LOCAL AND NATIONAL PUBLICATIONS, INCLUDING MEDICAL JOURNALS, NEWSPAPERS, RADIO SHOWS, MAGAZINES, AND HEALTHCARE WEBSITES.REPRESENTATIVES OF THE FOUNDATION REGULARLY ATTEND NATIONAL AND LOCAL HEALTHCARE CONFERENCES TO PROMOTE THE FOUNDATION'S PROGRAM, INCLUDING THOSE OF SUCH ENTITIES AS THE NATIONAL KIDNEY FUND, THE AMERICAN COLLEGE OF RHEUMATOLOGY, THE AMERICAN ACADEMY OF PEDIATRICS, CBI-PAP (PATIENT ASSISTANCE PROGRAMS), BIO, AND THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY.ADDITIONALLY, WHEN THE FOUNDATION ESTABLISHES A NEW FUND WITH RESPECT TO A PARTICULAR DISEASE OR CONDITION, THE FOUNDATION:IDENTIFIES KEY NATIONAL PATIENT ORGANIZATIONS AND MEDICAL SPECIALTY SOCIETIES THAT ARE ABLE TO REACH OUT TO PATIENTS IN THE NEW FUND AREA.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 32,000 INDIVIDUALS FOUR TIMES A YEAR.FURTHERMORE, THE FOUNDATION IS REFERENCED BY, OR IS LINKED TO, THE WEBSITES OF A NUMBER OF ORGANIZATIONS THAT DIRECT PATIENTS FOR CO-PAYMENT AND PREMIUM ASSISTANCE, INCLUDING NATIONAL PHARMACY CLAIMS, PATIENT ASSISTANCE PROGRAMS, PATIENT ADVOCACY GROUPS, AND OTHER COPAYMENT ASSISTANCE ORGANIZATIONS.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 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 57994 43318 14676 740315 286492 453823 468499 CO-PAYMENTS AND PREMIUM ASSISTANCE PAYABLE 2547904 2547904 53842195 65518601 -11676406 -361968 22031523 21669555 9993149 53346952 -361968 -361968 53708920 133275 133275 53842195 65385326 0 65385326 133275 133275 65518601 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION PERFORMED AN EVALUATION OF UNCERTAIN TAX POSITIONS FOR THE YEAR ENDED DECEMBER 31, 2011, 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 XI, LINE 8 - OTHER ADJUSTMENTS: PRIOR PERIOD ADJ. - CHANGE IN METHOD OF RECOGNIZING PATIENT GRANT EXPENSE 22,031,523. X X X 1 AB DATA GROUP 600 A B DATA DRIVE MILWAUKEE WI 53217 DIRECT MAIL CAMPAIGN 0 249714 186388 63326 249714 186388 63326 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 ACUTE PORPHYRIAS (AP) 2 5799 AGE-RELATED MACULAR DEGENERATION (AMD) 472 939297 ANCA-ASSOCIATED VASCULITIS AND WEGENERS (AAV) 42 30420 ANEMIA ASSOCIATED WITH CHRONIC RENAL INSUFFICIENCY/FAILURE (CRICRF) 1362 2159275 ANKYLOSING SPONDYLITIS (AS) 132 339580 ASTHMA - MODERATE TO SEVERE (ASTHMA) 3780 3235543 AUTOIMMUNE MEDICARE ACCESS (AI) 8180 10147619 BONE METASTASES (BM) 1320 403937 BREAST CANCER (BC) 623 2383657 CARCINOID TUMORS AND ASSOCIATED SYMPTOMS (CARCINOID) 151 587902 CHEMOTHERAPY INDUCED ANEMIA (CIA) 501 251581 CHEMOTHERAPY INDUCED NEUTROPENIA (CIN) 5666 4541051 CHRONIC GOUT (CG) 98 49949 CHRONIC MYELOID LEUKEMIA - MEDICARE ACCESS (CML-MA) 51 11061 CHRONIC MYELOID LEUKEMIA (CML) 234 340403 COLORECTAL CARCINOMA (CC) 557 2684504 CROHN'S DISEASE - MEDICARE ACCESS (CD) 323 373393 CUTANEOUS T-CELL LYMPHOMA (CTCL) 38 32349 CYTOMEGALOVIRUS DISEASE (CMV) 14 31458 DUPUYTREN'S DISEASE (DD) 215 99529 HEAD AND NECK CANCER (HNC) 648 551225 HEPATITIS B AND C (HBC) 12 88443 IDIOPATHIC THROMBOCYTOPENIC PUPURA (ITP) 391 315931 IMMUNOSUPPRESSIVE TREATMENT FOR SOLID ORGAN TRANSPLANT RECIPIENTS (ITSOTP) 2303 1782836 IRON OVERLOAD AS A RESULT OF BLOOD TRANSFUSIONS (IO) 65 334559 METASTATIC MELANOMA (METMEL) 331 341083 MULTIPLE MYELOMA (MM) 1 6279 NON-HODGKINS LYMPHOMA (NHL) 1010 1800263 NON-SMALL CELL LUNG CANCER (NSCLC) 25 75182 POST MENOPAUSAL OSTEOPOROSIS (PMO) 1889 318058 PSORIASIS (PSO) 507 1627730 PSORIATIC ARTHRITIS (PSA) 313 895812 RHEUMATOID ARTHRITIS (RA) 2442 6761361 SECONDARY HYPERPARATHYROIDISM (SHPT) 6103 5849760 SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) 224 87726 MYELODYSPLASTIC SYNDROMES (MDS) 1 590 HODGKINS (HD) 1 20 GLIOBLASTOMA MULTIFORME/ANAPLASTIC ASTROCYTOMA (GBMAA) 1 4235 SPECIAL DONATIONS 8 32377 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: EACH PATIENT SEEKING ASSISTANCE IS SCREENED FOR ELIGIBILITY EITHER BY A HEALTHWELL REPRESENTATIVE OR THROUGH OUR ONLINE APPLICATION TOOL. CRITERIA IS STATIC ACROSS ALL HEALTHWELL FUNDS: THE PATIENT'S HOUSEHOLD INCOME MAY BE UP TO 400% OF THE FEDERAL POVERTY LIMIT, ADJUSTED FOR HOUSEHOLD SIZE AND HIGH COST OF LIVING AREAS; THE PATIENT MUST HAVE A DIAGNOSIS THAT HEALTHWELL 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 A PATIENT IS PRE-QUALIFIED FOR A GRANT, THEY HAVE 30 DAYS DURING WHICH TIME THEY MUST SUBMIT TO HEALTHWELL A COMPLETED AND SIGNED STATEMENT OF TREATMENT FORM AND COPIES OF THEIR MEDICAL INSURANCE AND PRESCRIPTION CARDS - FRONT AND BACK. UNTIL HEALTHWELL RECEIVES THESE DOCUMENTS, NO PAYMENTS WILL BE CONSIDERED OR REVIEWED FOR REIMBURSEMENT. UPON RECEIPT AND REVIEW OF THE STATEMENT OF TREATMENT AND INSURANCE AND PRESCRIPTION CARD COPIES, IF THE DOCUMENTATION IS 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, HEALTHWELL 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 HEALTHWELL 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 MARY P SUNDEEN 238680 0 34157 0 0 0 16828 0 24886 0 314551 0 0 0 SHELA HALPER 160240 0 5508 0 0 0 8521 0 11576 0 185845 0 0 0 BASKARAN VELLANDURAI 158741 0 5200 0 0 0 7986 0 12224 0 184151 0 0 0 KRISTA ZODET 136148 0 4131 0 0 0 6380 0 8969 0 155628 0 0 0 PART I, LINE 7 ALL BONUS PAYMENTS RECEIVED BY OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES LISTED IN FORM 990, PART VII ARE BASED ON AN APPRAISAL OF HIS/HER PERFORMANCE. SUPPLEMENTAL INFORMATION PART III 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, 2011, THE FOUNDATION PAID A TOTAL OF $17,825 TO THE UNRELATED ORGANIZATION FOR THE TIME INCURRED BY MR. WEINER. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 THE HEALTHWELL FOUNDATION ENHANCED THE GRANTS MANAGEMENT SYSTEM, CONTRACTED WITH A NEW PHARMACY CARD VENDOR, STREAMLINED THE GRANT APPLICATION PROCESS, AND INSTITUTED A FRAUD AUDIT PROCESS. FORM 990, PART VI, SECTION B, LINE 11 THE PRESIDENT, HEALTHWELL DIRECTORS, AND THE ACCOUNTING MANAGER REVIEW THE FEDERAL FORM 990 AND THEN FORWARD IT TO THE TREASURER FOR REVIEW. UPON COMPLETION OF REVIEW, THE PRESIDENT SIGNS THE FEDERAL FORM 990 AND RETURNS IT 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 STAFF AND BOARD OF DIRECTORS FOLLOW A CODE OF CONDUCT. THE MEMBERS OF THE BOARD OF DIRECTORS SIGN A CONFLICT OF INTEREST DISCLOSURE ANNUALLY. MEMBERS THAT ARE DEEMED TO HAVE A CONFLICT OF INTEREST BASED ON THE ABOVE PROCESS ARE RECUSED FROM PARTICIPATING IN A VOTE WITHIN THAT AREA OF CONFLICT. 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -361,968. PRIOR PERIOD ADJ. - CHANGE IN METHOD OF RECOGNIZING PATIENT GRANT EXPENSE 22,031,523. TOTAL TO FORM 990, PART XI, LINE 5: 21,669,555.