Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 01-01-2018 , and ending 12-31-2018
BCheck if applicable:
CName of organization
GARY AND MARY WEST HEALTH INSTITUTE
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
10350 NORTH TORREY PINES ROAD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LA JOLLA, CA92037
D Employer identification number

26-4146730
E Telephone number

G Gross receipts $ 25,825,087
F Name and address of principal officer:
SHELLEY LYFORD
10350 NORTH TORREY PINES ROAD
LA JOLLA,CA92037
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.WESTHEALTH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 2009
M State of legal domicile: DE
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: CONDUCTING MEDICAL RESEARCH WITH HOSPITALS TO REDUCE HEALTHCARE COSTS WITH A FOCUS ON SENIORS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 5
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 3
5 Total number of individuals employed in calendar year 2018 (Part V, line 2a) ...... 5 29
6 Total number of volunteers (estimate if necessary) ............. 6 5
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 31,032
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 15,750,000 25,750,000
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -4,553,446 87
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 85,115 75,000
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 11,281,669 25,825,087
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 19,133 47,392
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 4,463,400 4,843,533
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 18,018,155 21,963,511
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 22,500,688 26,854,436
19 Revenue less expenses. Subtract line 18 from line 12....... -11,219,019 -1,029,349
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 12,439,679 12,461,358
21 Total liabilities (Part X, line 26)............. 5,408,254 6,459,282
22 Net assets or fund balances. Subtract line 21 from line 20..... 7,031,425 6,002,076
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2018)
Form 990 (2018)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 19,718,125 including grants of $ 47,392 ) (Revenue $   )
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.
4b (Code:   ) (Expenses $ 463,621 including grants of $   ) (Revenue $   )
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.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet20,181,746
Form 990 (2018)
Form 990 (2018)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part IIIClick to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
Form 990 (2018)
Form 990 (2018)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV........................Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
37
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2018)
Form 990 (2018)
Page 5
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
29
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N .....
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O ................
16
 
No
Form 990 (2018)
Form 990 (2018)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
5
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
3
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA , DE
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletSALLY HALLAK10350 N TORREY PINES ROAD   LA JOLLA,CA92037 (858) 535-7000
Form 990 (2018)
Form 990 (2018)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) CHARLES SEDERSTROM......................................................................
DIR./SECRETARY THRU 12/14/18
 5.00
.................
1.00 		X   X       0 0 0
(2) GARY L WEST......................................................................
DIRECTOR, CHAIRMAN
 15.00
.................
10.00 		X           0 0 0
(3) MARK MCCLELLAN......................................................................
DIRECTOR
 10.00
.................
5.00 		X           0 0 0
(4) MICHAEL SCHATZLEIN MD......................................................................
DIRECTOR
 10.00
.................
0.00 		X           0 0 0
(5) NICHOLAS VALERIANI......................................................................
DIRECTOR
 15.00
.................
5.00 		X           0 0 0
(6) THOMAS CULHANE......................................................................
DIRECTOR
 0.00
.................
1.00 		X           0 0 0
(7) SHELLEY M LYFORD......................................................................
PRESIDENT & CEO
 40.00
.................
15.00 		    X       597,132 22,917 11,807
(8) ZIA AGHA......................................................................
CHIEF MEDICAL OFFICER & EVP
 40.00
.................
0.00 		    X       631,184 0 46,251
(9) WILLIAM T EARLEY......................................................................
SECRETARY/TREASURER/CAO/GENERAL COUNSEL
 40.00
.................
10.00 		    X       0 418,903 42,762
(10) VALERIE VOLPE......................................................................
VP GOVT AFFAIRS THRU 3/2018
 50.00
.................
0.00 		    X       0 320,292 10,877
(11) TIMOTHY LASH......................................................................
EVP/CHIEF STRATEGY OFFICER
 40.00
.................
10.00 		    X       0 590,493 35,349
(12) DIANA CAMPAU......................................................................
VP COMMUNICATIONS
 50.00
.................
0.00 		    X       0 388,169 49,092
(13) SALLY HALLAK......................................................................
TREASURER THRU 12/14/18
 40.00
.................
10.00 		    X       0 187,822 18,793
(14) ADRIAN KWONG......................................................................
DATA SCIENCE ADMINISTRATOR
 50.00
.................
0.00 		        X   188,906 0 26,762
(15) CHRISTOPHER CROWLEY......................................................................
PROGRAM MANAGER
 50.00
.................
0.00 		        X   220,320 0 33,618
(16) GREGORY NORMAN......................................................................
SR. DIR, CLINICAL RESEARCH
 50.00
.................
0.00 		        X   237,110 0 13,579
(17) JONATHAN ZIFFERBLATT......................................................................
VP, STRATEGY AND SUCCESSFUL AGING
 50.00
.................
0.00 		        X   211,955 87,884 37,693
Form 990 (2018)
Form 990 (2018)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) JOSE UNPINGCO........................................................................
SR. DIRECTOR DATA SCIENCE
 50.00
.......................0.00 		        X   248,020 0 41,705
(19) JOSEPH SMITH........................................................................
FORMER CO-MANAGER/CMO THRU 3/31/16
 0.00
.......................50.00 		          X 0 796,464 33,218
(20) NANCY SCHROEDER........................................................................
SR DIR COMM THRU 5/17/15
 40.00
.......................0.00 		          X 0 184,363 41,393




















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 2,334,627 2,997,307 442,899
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet12
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
WAXMAN STRATEGIES

1150 CONNECTICUT AVE NW SUITE 800
WASHINGTON,DC20036 		CONSULTANTS 630,688
WILLIAM SCANLON,
3055 CROSEN COURT
HERNDON,VA20171 		CONSULTANTS 240,298
TELEOMED LABS CORPORATION

2902 CANYON ROAD
BURLINGAME,CA94010 		CONSULTANTS 207,120
COMMUNICATION PARTNERS & ASSOCIATES LLC

7 WORLD TRADE CENTER
NEW YORK,NY10007 		CONSULTANTS 180,000
GALLUP INC

PO BOX 310284
DES MOINES,IA503310284 		CONSULTANTS 161,475
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet13
Form 990 (2018)
Form 990 (2018)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 25,750,000
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$  
h Total. Add lines 1a-1f.......MediumBullet 25,750,000
Program Service RevenueAmt Business Code
2a
b
c
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f ....MediumBullet  
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 87     87
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet 75,000 75,000    
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss)......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss).....MediumBullet        
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 25,825,087 75,000 0 87
Form 990 (2018)
Form 990 (2018)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 47,392 47,392
2 Grants and other assistance to domestic individuals. See Part IV, line 22    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,197,915 863,766 334,149  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 2,995,037 2,953,222 41,815  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 114,089 115,259 -1,170  
9 Other employee benefits ....... 303,241 302,786 455  
10 Payroll taxes ........... 233,251 215,957 17,294  
11 Fees for services (non-employees):        
a Management ...... 3,419,262 827,301 2,591,961  
b Legal ......... 205,861 157,327 48,534  
c Accounting ........... 45,004   45,004  
d Lobbying ........... 430,000 430,000    
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 13,933,634 12,071,037 1,862,597  
12 Advertising and promotion ....        
13 Office expenses ....... 23,936 2,666 21,270  
14 Information technology ...... 393,367 139,159 254,208  
15 Royalties ..        
16 Occupancy ........... 1,736,835 1,023,083 713,752  
17 Travel ............ 550,661 400,656 150,005  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 92,409 75,462 16,947  
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 560,340 301,570 258,770  
23 Insurance ... 84,959 30,237 54,722  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a TELECOMMUNICATIONS/WEB 167,662 116,196 51,466  
b SUBSCRIPTIONS & PUBLICA 114,879 54,718 60,161  
c RECRUITING & RETENTION 106,729 6,316 100,413  
d OTHER 57,279 33,355 23,924  
e All other expenses 40,694 14,281 26,413  
25 Total functional expenses. Add lines 1 through 24e 26,854,436 20,181,746 6,672,690 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2018)
Form 990 (2018)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 3,471,548 1 4,114,998
2 Savings and temporary cash investments ......... 34,377 2 759,012
3 Pledges and grants receivable, net ...... 5,750,000 3 5,000,000
4 Accounts receivable, net ............. 243,039 4 150,319
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
  6  
7 Notes and loans receivable, net ....   7  
8 Inventories for sale or use ........   8  
9 Prepaid expenses and deferred charges ...... 1,070,014 9 900,646
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 10,461,523
b Less: accumulated depreciation 10b 9,081,865 1,613,855 10c 1,379,658
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 ..... 0 12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ............... 256,846 14 156,725
15 Other assets. See Part IV, line 11 ...........   15  
16 Total assets. Add lines 1 through 15 (must equal line 34)... 12,439,679 16 12,461,358
Liabilities 17 Accounts payable and accrued expenses ..... 4,105,266 17 5,430,037
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 1,302,988 25 1,029,245
26 Total liabilities. Add lines 17 through 25.. 5,408,254 26 6,459,282
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 7,031,425 27 6,002,076
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 7,031,425 33 6,002,076
34 Total liabilities and net assets/fund balances ........ 12,439,679 34 12,461,358
Form 990 (2018)
Form 990 (2018)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
25,825,087
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
26,854,436
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-1,029,349
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
7,031,425
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
3,000
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-3,000
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
6,002,076
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2018)
Form 990 (2018)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number

26-4146730
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9

10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2018 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2018 		(iii)
Distributable
Amount for 2018
1 Distributable amount for 2018 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2018:
a From 2013.......  
b From 2014.......  
c From 2015.......  
d From 2016.......  
e From 2017.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2018 distributable amount  
i Carryover from 2013 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2018 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2018 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2018, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2018. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2019. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2014......  
b Excess from 2015.....  
c Excess from 2016.....  
d Excess from 2017.....  
e Excess from 2018.....  
Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2018


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number

26-4146730
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2
Name of organization
GARY AND MARY WEST HEALTH INSTITUTE
  		Employer identification number
26-4146730
Part I
Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Page 3
Name of organization
GARY AND MARY WEST HEALTH INSTITUTE
  		Employer identification number

26-4146730
Part II
Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Page 4
Name of organization
GARY AND MARY WEST HEALTH INSTITUTE
  		Employer identification number

26-4146730
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data


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SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number

26-4146730
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2018

Schedule C (Form 990 or 990-EZ) 2018
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ............................... 430,000  
c Total lobbying expenditures (add lines 1a and 1b) ................................................................... 430,000  
d Other exempt purpose expenditures ........................................................................ 26,427,436  
e Total exempt purpose expenditures (add lines 1c and 1d) ............................................... 26,857,436  
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		 1,000,000  
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) ................................................. 250,000  
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................ 0  
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................ 0  
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) Total
2a Lobbying nontaxable amount 942,976 955,002 1,000,000 1,000,000 3,897,978
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		5,846,967
c Total lobbying expenditures 82,873 219,529 230,184 430,000 962,586
d Grassroots nontaxable amount 235,744 238,751 250,000 250,000 974,495
e Grassroots ceiling amount
(150% of line 2d, column (e))		 1,461,743
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2018


Schedule C (Form 990 or 990-EZ) 2018
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
 
c
Media advertisements? ...................................................................................................
 
 
 
d
Mailings to members, legislators, or the public? .............................................................................
 
 
 
e
Publications, or published or broadcast statements? ...........................................................
 
 
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
 
 
i
Other activities? ...................................................................................................................
 
 
 
j
Total. Add lines 1c through 1i ....................................................................................................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
SCHEDULE C, PART IV THE GARY AND MARY WEST HEALTH INSTITUTE DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE.
Schedule C (Form 990 or 990EZ) 2018


Additional Data


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SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number

26-4146730
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
 
(ii) related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....      
b Buildings ....        
c Leasehold improvements   6,796,829 5,899,870 896,959
d Equipment ....   2,026,849 1,846,649 180,200
e Other .....   1,637,845 1,335,346 302,499
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 1,379,658
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
DEFERRED LEASE/RENT 484,602
LEASE INCENTIVE LIABILITY 544,643
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,029,245
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 25,828,087
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b 3,000
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e 3,000
3 Subtract line 2e from line 1.................. 3 25,825,087
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c 0
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 25,825,087
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 26,857,436
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a 3,000
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e 3,000
3 Subtract line 2e from line 1................... 3 26,854,436
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 26,854,436
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART X, LINE 2: IN JULY 2006, THE FINANCIAL ACCOUNTING STANDARDS BOARD ("FASB") ISSUED ACCOUNTING STANDARDS CODIFICATION ("ASC") 740, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND PRESCRIBES A THRESHOLD OF MORE-LIKELY THAN-NOT FOR RECOGNITION OF TAX BENEFITS OF UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. 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.
Schedule D (Form 990) 2018


Additional Data


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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number
26-4146730
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) GARY AND MARY WEST SENIOR SERVICES INC
1706 DESCANSO AVENUE
SAN MARCOS,CA92078 		85-0635784     47,392 FMV OFFICE SPACE DONATION OF OFFICE SPACE
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
0
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2018

Schedule I (Form 990) 2018
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: GRANTS WILL ONLY BE MADE TO 501(C)(3) ORGANIZATIONS TO ENSURE THE NON-CASH ITEMS WILL BE USED PROPERLY.
Schedule I (Form 990) 2018



Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number

26-4146730
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1SHELLEY M LYFORD
PRESIDENT & CEO 		(i)

(ii)		 450,445
-------------
22,917 		127,500
-------------
0 		19,187
-------------
0 		10,277
-------------
0 		1,530
-------------
0 		608,939
-------------
22,917 		0
-------------
0
2ZIA AGHA
CHIEF MEDICAL OFFICER & EVP 		(i)

(ii)		 511,822
-------------
0 		100,000
-------------
0 		19,362
-------------
0 		13,750
-------------
0 		32,501
-------------
0 		677,435
-------------
0 		0
-------------
0
3WILLIAM T EARLEY
SECRETARY/TREASURER/CAO/GENERAL COUN 		(i)

(ii)		 0
-------------
324,009 		0
-------------
75,000 		0
-------------
19,894 		0
-------------
13,750 		0
-------------
29,012 		0
-------------
461,665 		0
-------------
0
4VALERIE VOLPE
VP GOVT AFFAIRS THRU 3/2018 		(i)

(ii)		 0
-------------
50,981 		0
-------------
56,430 		0
-------------
212,881 		0
-------------
0 		0
-------------
10,877 		0
-------------
331,169 		0
-------------
0
5TIMOTHY LASH
EVP/CHIEF STRATEGY OFFICER 		(i)

(ii)		 0
-------------
446,618 		0
-------------
125,000 		0
-------------
18,875 		0
-------------
7,115 		0
-------------
28,234 		0
-------------
625,842 		0
-------------
0
6DIANA CAMPAU
VP COMMUNICATIONS 		(i)

(ii)		 0
-------------
323,745 		0
-------------
63,000 		0
-------------
1,424 		0
-------------
13,750 		0
-------------
35,342 		0
-------------
437,261 		0
-------------
0
7SALLY HALLAK
TREASURER THRU 12/14/18 		(i)

(ii)		 0
-------------
163,684 		0
-------------
24,000 		0
-------------
138 		0
-------------
9,440 		0
-------------
9,353 		0
-------------
206,615 		0
-------------
0
8ADRIAN KWONG
DATA SCIENCE ADMINISTRATOR 		(i)

(ii)		 172,840
-------------
0 		15,841
-------------
0 		225
-------------
0 		8,750
-------------
0 		18,012
-------------
0 		215,668
-------------
0 		0
-------------
0
9CHRISTOPHER CROWLEY
PROGRAM MANAGER 		(i)

(ii)		 201,717
-------------
0 		17,809
-------------
0 		794
-------------
0 		11,081
-------------
0 		22,537
-------------
0 		253,938
-------------
0 		0
-------------
0
10GREGORY NORMAN
SR. DIR, CLINICAL RESEARCH 		(i)

(ii)		 211,968
-------------
0 		24,695
-------------
0 		447
-------------
0 		11,833
-------------
0 		1,746
-------------
0 		250,689
-------------
0 		0
-------------
0
11JONATHAN ZIFFERBLATT
VP, STRATEGY AND SUCCESSFUL AGING 		(i)

(ii)		 190,703
-------------
87,750 		20,968
-------------
0 		284
-------------
134 		10,302
-------------
3,448 		16,413
-------------
7,530 		238,670
-------------
98,862 		0
-------------
0
12JOSE UNPINGCO
SR. DIRECTOR DATA SCIENCE 		(i)

(ii)		 215,766
-------------
0 		31,950
-------------
0 		304
-------------
0 		12,567
-------------
0 		29,138
-------------
0 		289,725
-------------
0 		0
-------------
0
13JOSEPH SMITH
FORMER CO-MANAGER/CMO THRU 3/31/16 		(i)

(ii)		 0
-------------
795,346 		0
-------------
0 		0
-------------
1,118 		0
-------------
0 		0
-------------
33,218 		0
-------------
829,682 		0
-------------
0
14NANCY SCHROEDER
SR DIR COMM THRU 5/17/15 		(i)

(ii)		 0
-------------
167,047 		0
-------------
16,974 		0
-------------
342 		0
-------------
9,548 		0
-------------
31,845 		0
-------------
225,756 		0
-------------
0
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
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.
Schedule J (Form 990) 2018
Additional Data


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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number

26-4146730
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2018
Schedule L (Form 990 or 990-EZ) 2018
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) SEE PART V DISCLOSURE
  		        No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
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.
Schedule L (Form 990 or 990-EZ) 2018


Additional Data


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Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number

26-4146730
Return Reference Explanation
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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
GARY AND MARY WEST HEALTH INSTITUTE
 
Employer identification number

26-4146730
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)GARY AND MARY WEST HEALTH POLICY CENTER
1909 K STREET NW SUITE 730

WASHINGTON,DC20006
27-5388874 		SEE SCH R, PART VII DE 501(C)(3) PF N/A
 
No
(2)GARY AND MARY WEST HEALTH ENDOWMENT INC
1603 ORRINGTON AVE SUITE 810

EVANSTON,IL60201
27-2953865 		FINANCIAL SUPPORT DE 501(C)(3) 11 N/A
 
No










For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) REFLEXION HEALTH INC

225 BROADWAY SUITE 650
SAN DIEGO,CA92101
45-5417842 		SEE SCH R, PART VII DE DIGITAL HEALTH CORP
  		C         No
(2) GARY AND MARY WEST MANAGEMENT COMPANY INC

5800 ARMADA DRIVE SUITE 100
CARLSBAD,CA92008
45-4040871 		SEE SCH R, PART VII DE N/A
 C         No
(3) DIGITAL HEALTH CORP

225 BROADWAY SUITE 300
SAN DIEGO,CA92101
82-0903337 		SEE SCH R, PART VII DE GARY AND MARY WEST HEALTH ENDOWMENTINC
  		C         No








Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
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.
Schedule R (Form 990) 2018

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