TY 2019 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) CHARLES SEDERSTROM...................................................................... DIRECTOR	5.00 ................. 1.00	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 (THROUGH 04/03/2019)	10.00 ................. 0.00	X			0	0	0
(5) NICHOLAS VALERIANI...................................................................... DIRECTOR	15.00 ................. 5.00	X			0	0	0
(6) DIANA CAMPAU...................................................................... VP COMMUNICATIONS (THROUGH 8/1/2019)	50.00 ................. 0.00		X		0	278,338	34,499
(7) SALLY HALLAK...................................................................... SECRETARY	40.00 ................. 15.00		X		0	211,450	20,413
(8) SHELLEY M LYFORD...................................................................... PRESIDENT & CEO	40.00 ................. 15.00		X		651,217	94,929	14,450
(9) SIOBHAN GRAHAM...................................................................... VP, OPERATIONS & HR	50.00 ................. 0.00		X		0	208,283	21,020
(10) TIMOTHY LASH...................................................................... EVP/CHIEF STRATEGY OFFICER	40.00 ................. 15.00		X		595,431	81,953	34,952
(11) WILLIAM T EARLEY...................................................................... TREAS,COO &COUNSEL(THROUGH 5/24/19)	40.00 ................. 10.00		X		0	269,558	26,062
(12) ZIA AGHA...................................................................... CHIEF MEDICAL OFFICER & EV	40.00 ................. 0.00		X		639,985	0	48,214
(13) ADRIAN KWONG...................................................................... PRINCIPAL DATA SECURITY ARCHITECT	50.00 ................. 0.00			X	196,656	0	24,392
(14) AMY STUCK...................................................................... SNR DIRECTOR, ACUTE CARE	50.00 ................. 0.00			X	186,016	0	50,261
(15) CHRISTOPHER CROWLEY...................................................................... PROGRAM MANAGER	50.00 ................. 0.00			X	220,384	0	32,151
(16) JOSE UNPINGCO...................................................................... SR. DIRECTOR DATA SCIENCE	50.00 ................. 0.00			X	252,368	0	38,545
(17) KELLY KO...................................................................... DIRECTOR, CLINICAL RESEARCH	50.00 ................. 0.00			X	186,271	0	34,385

(A) Name and business address	(B) Description of services	(C) Compensation
GALLUP INC PO BOX 310284 DES MOINES,IA503310284	CONSULTANTS	484,425
WAXMAN STRATEGIES 1150 CONNECTICUT AVE NW SUITE 800 WASHINGTON,DC20036	CONSULTANTS	437,300
WILLIAM SCANLON, 3055 CROSEN COURT HERNDON,VA20171	CONSULTANTS	238,428
COMMUNICATION PARTNERS & ASSOCIATES LLC 7 WORLD TRADE CENTER NEW YORK,CA10007	CONSULTANTS	232,000
WEST DEVELOPMENT LLC 5800 ARMADA DR STE 100 CARLSBAD,CA92008	CONSULTANTS	171,125
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 5

- TIN:

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.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

UNIVERSITY OF CALIFORNIA IRVINE SENIOR HEALTH CENTER

IRVINE

UNIVERSITY OF CALIFORNIA SAN DIEGO HEALTH SYSTEM

LA JOLLA

JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE

BALTIMORE

MOUNT SINAI HOSPITAL

NEW YORK

THE REGENTS OF THE UNIVERSITY OF CALIFORNIA

SAN FRANCISCO

THE FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH

MANHASSET

GARY AND MARY WEST SENIOR SERVICES

SAN MARCOS

BELLIN MEMORIAL HOSPITAL

GREEN BAY

BETH ISRAEL DEACONESS MEDICAL CENTER

BOSTON

ATRIUS HEALTH

NEWTON

THE UNIVERSITY OF N CAROLINA AT CHAPEL HILL

CHAPEL HILL

PARK NICOLLET CLINIC

ST LOUIS

DARTMOUTH-HITCHCOCK CLINIC

LEBANON

INTEGRATED HEALTHCARE ALLIANCE

SAN DIEGO

SPECTRUM HEALTH SYSTEM

GRAND RAPIDS

THOMAS JEFFERSON UNIVERSITY HOSPITALS INC

PHILADELPHIA

WHITE PLAINS HOSPITAL

WHITE PLAINS

GEISINGER CLINIC

DANVILLE

GROUP HEALTH PLAN INC DBA HEALTHPARTNERS

MINNEAPOLIS

HEBREW REHABILITATION CENTER

BOSTON

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


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) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2019

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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)..

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

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

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

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

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.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

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.

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) .

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).

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.

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.

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.

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

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) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

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?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, 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 2019. 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 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

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

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization GARY AND MARY WEST HEALTH INSTITUTE

Part I Contributors	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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

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 Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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.

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

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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) 2019

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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) ........................	402,000
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................	402,000
d	Other exempt purpose expenditures ...............................................................................	23,732,325
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................	24,134,325
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? ...................................................................................................................		Yes No

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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount	955,002	1,000,000	1,000,000	1,000,000	3,955,002

b	Lobbying ceiling amount (150% of line 2a, column(e))					5,932,503

c	Total lobbying expenditures	219,529	230,184	430,000	402,000	1,281,713

d	Grassroots nontaxable amount	238,751	250,000	250,000	250,000	988,751

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,483,127

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

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)

Yes|No

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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 instructions and the latest information.

OMB No. 1545-0047

2019

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB 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

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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	6,226,037	570,792
d	Equipment ....	2,055,963	1,932,360	123,603
e	Other .....	1,634,160	1,364,136	270,024
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				964,419

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

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
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	703,115
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) 2019

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	23,004,748
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	23,001,748
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	23,001,748

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	24,134,325
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	24,131,325
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	24,131,325

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 ACCORDANCE WITH FASB ASC 740, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE INSTITUTE EVALUATES ANNUALLY ANY UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN BY APPLYING A THRESHOLD OF MORE LIKELY THAN NOT FOR RECOGNITION. MANAGEMENT EVALUATED ITS TAX POSITIONS AND DETERMINED THAT IT HAS NO UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2019. 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) 2019

Additional Data

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- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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

2019

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

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? ........................

Yes No

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	82-0635784	501(C)(3)		8,260	FMV	FURNITURE AND DONATED SERVICES	DONATIO OF OFFICE FURNITURE AND SERVICES
(2) GARY AND MARY WEST SENIOR DENTAL CENTER INC 1525 FOURTH AVE SAN DIEGO,CA92101	47-3001738	501(C)(3)		11,020	FMV	OFFICE SPACE	DONATION OF OFFICE SPACE

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

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) 2019

Additional Data

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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

2019

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

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .........

Yes

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 on Line 1a? ..

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

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:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

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 ............

Yes

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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DIANA CAMPAU VP COMMUNICATIONS (THROUGH 8/1/2019)	(i) (ii)	0 ------------- 193,779	0 ------------- 52,164	0 ------------- 32,395	0 ------------- 11,241	0 ------------- 23,258	0 ------------- 312,837	0 ------------- 0
2SALLY HALLAK SECRETARY	(i) (ii)	0 ------------- 181,570	0 ------------- 29,720	0 ------------- 160	0 ------------- 10,622	0 ------------- 9,791	0 ------------- 231,863	0 ------------- 0
3SHELLEY M LYFORD PRESIDENT & CEO	(i) (ii)	481,557 ------------- 25,000	150,000 ------------- 0	19,660 ------------- 69,929	10,640 ------------- 0	3,810 ------------- 0	665,667 ------------- 94,929	0 ------------- 69,929
4SIOBHAN GRAHAM VP, OPERATIONS & HR	(i) (ii)	0 ------------- 179,049	0 ------------- 29,000	0 ------------- 234	0 ------------- 10,460	0 ------------- 10,560	0 ------------- 229,303	0 ------------- 0
5TIMOTHY LASH EVP/CHIEF STRATEGY OFFICER	(i) (ii)	446,071 ------------- 25,000	130,000 ------------- 0	19,360 ------------- 56,953	7,300 ------------- 0	27,652 ------------- 0	630,383 ------------- 81,953	0 ------------- 56,953
6WILLIAM T EARLEY TREAS,COO &COUNSEL(THROUGH 5/24/19)	(i) (ii)	0 ------------- 149,212	0 ------------- 93,750	0 ------------- 26,596	0 ------------- 13,524	0 ------------- 12,538	0 ------------- 295,620	0 ------------- 0
7ZIA AGHA CHIEF MEDICAL OFFICER & EV	(i) (ii)	523,594 ------------- 0	96,563 ------------- 0	19,828 ------------- 0	14,000 ------------- 0	34,214 ------------- 0	688,199 ------------- 0	0 ------------- 0
8ADRIAN KWONG PRINCIPAL DATA SECURITY ARCHITECT	(i) (ii)	178,921 ------------- 0	17,500 ------------- 0	235 ------------- 0	9,056 ------------- 0	15,336 ------------- 0	221,048 ------------- 0	0 ------------- 0
9AMY STUCK SNR DIRECTOR, ACUTE CARE	(i) (ii)	169,754 ------------- 0	15,627 ------------- 0	635 ------------- 0	9,454 ------------- 0	40,807 ------------- 0	236,277 ------------- 0	0 ------------- 0
10CHRISTOPHER CROWLEY PROGRAM MANAGER	(i) (ii)	201,840 ------------- 0	17,324 ------------- 0	1,220 ------------- 0	11,057 ------------- 0	21,094 ------------- 0	252,535 ------------- 0	0 ------------- 0
11JOSE UNPINGCO SR. DIRECTOR DATA SCIENCE	(i) (ii)	222,264 ------------- 0	29,618 ------------- 0	486 ------------- 0	12,780 ------------- 0	25,765 ------------- 0	290,913 ------------- 0	0 ------------- 0
12KELLY KO DIRECTOR, CLINICAL RESEARCH	(i) (ii)	161,397 ------------- 0	24,750 ------------- 0	124 ------------- 0	9,488 ------------- 0	24,897 ------------- 0	220,656 ------------- 0	0 ------------- 0
13JOSEPH M SMITH FORMER CO-MANAGER/CMO(THRU 3/31/16)	(i) (ii)	0 ------------- 803,727	0 ------------- 0	0 ------------- 1,634	0 ------------- 25,000	0 ------------- 32,634	0 ------------- 862,995	0 ------------- 0

Schedule J (Form 990) 2019

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, LINE 3	COMPENSATION FOR THE CEO WAS ESTABLISHED BY THE BOARD OF DIRECTORS OF THE GARY AND MARY WEST HEALTH INSTITUTE AND PAID BY THE INSTITUTE. THE FOLLOWING WAS USED TO ESTABLISH THE COMPENSATION: 1)COMPENSATION COMMITTEE; 2)FORM 990 OF OTHER ORGANIZATIONS; 3)COMPENSATION SURVEY OR STUDY; 4)APPROVAL BY THE BOARD OF DIRECTORS.
PART I, LINES 4A-B	EACH OF THE FOLLOWING INDIVIDUALS TIM LASH, 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 2019 THIS AMOUNT WAS $19,000. CONTRIBUTIONS WERE MADE FOR TIM LASH, ZIA AGHA AND SHELLEY LYFORD. EACH OF THE FOLLOWING INDIVIDUALS TIM LASH, 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 2019 THIS AMOUNT WAS $19,000. CONTRIBUTIONS WERE MADE FOR TIM LASH, ZIA AGHA AND SHELLEY LYFORD. TIM LASH AND SHELLEY LYFORD WERE TERMINATED FROM THE GARY AND MARY WEST MANAGEMENT COMPANY WHERE THEY PARTICIPATED IN THE 409A NONQUALIFIED DEFINED CONTRIBUTION PLAN AND TRANSFERRED TO THE INSTITUTE PLAN EFFECTIVE 1/1/2019. EACH OF THEM RECEIVED A DISTIBUTION ($56,953 FOR TIM LASH AND $69,929 FOR SHELLEY LYFORD) IN 2019 FROM GARY AND MARY WEST MANAGEMENT COMPANY. WILLIAM EARLEY ALSO 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. WILLIAM EARLEY WAS SEPARATED ON 5/24/2019 AND RECEIVED A DISTRIBUTION OF $38,641 FROM GARY AND MARY WEST MANAGEMENT COMPANY.
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) 2019

Additional Data

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 section 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

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) 2019

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	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	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 2019, TOTAL TRANSACTION AMOUNT IS $181,406 FOR IT CONSULTING SERVICES.
PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS	GARY AND MARY WEST SENIOR SERVICES, INC. ("GMWSS") AND WEST HEALTH INSTITUTE ("WHI") SHARE COMMON OFFICERS, TIMOTHY LASH AND ZIA AGHA. IN 2019, GMWSS AND WHI ENTERED INTO A JOINT RESEARCH COLLABORATION AGREEMENT VALUED AT $1,875,000.

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

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Software Version:

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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

2019

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, DESCRIPTION OF PROGRAM SERVICES	THE PROJECT HAS IDENTIFIED OPPORTUNITIES FOR STATES TO IMPROVE CARE AND REDUCE COSTS, ADDRESS STATE-SPECIFIC CHALLENGES IN IMPLEMENTING PAYMENT REFORMS, AND IMPROVE THEIR CAPABILITIES TO DRIVE INITIATIVES FORWARD, TAKING INTO ACCOUNT THE VARYING CAPACITIES OF STATES TO IMPLEMENT REFORMS, DEVELOP EVIDENCE, AND PROVIDE RESOURCES ACCORDINGLY. THE WORK COMPLEMENTS EXISTING TECHNICAL AND CONSULTING RESOURCES AVAILABLE TO STATES AND PROVIDES STRATEGIC SUPPORT TO OTHER INITIATIVES SUPPORTING STATE-BASED HEALTH CARE REFORM. DRIVE TRANSPARENCY IN THE HEALTH CARE SYSTEM ACROSS SEVERAL AXES TRANSPARENCY, IN A VARIETY OF CONTEXTS, IS A VITAL COMPONENT OF ADDRESSING EXORBITANT HEALTH CARE COSTS. IN 2019, WHI LEVERAGED ITS DATA SCIENCE CAPABILITIES TO DRIVE QUANTITATIVE/QUALITATIVE RESEARCH AND VISUALIZATIONS SUPPORTING A WELL-TIMED ISSUE BRIEF EXPOSING TREMENDOUS VARIATION IN PAYMENTS ACROSS CALIFORNIA HOSPITALS. FURTHER WORK TO ENHANCE THE PUBLIC REACH OF THESE RESULTS THROUGH INTERACTIVE WEB-BASED TOOLS AS WELL AS THE SCOPE TO THE WORK TO BEYOND CALIFORNIA IS PLANNED. ADVANCING SENIOR-APPROPRIATE ACUTE CARE MODELS IN 2019, THE INSTITUTE CONTINUED TO EXPAND ITS RESEARCH PORTFOLIO TO BUILD EVIDENCE AND SPREAD A NEW VISION FOR UNPLANNED ACUTE CARE. RECOGNIZING THAT UNPLANNED ACUTE CARE FUNDAMENTALLY DRIVES THE MAJORITY OF COST FOR OUR NATION'S VULNERABLE SENIORS AS WELL AS RESULTING IN DEBILITATION AND FUNCTIONAL DECLINE AFTER INPATIENT HOSPITAL STAYS, THE INSTITUTE ENVISIONS MORE PROACTIVE, OPPORTUNISTIC CARE THAT IS DELIVERED IN PLACE, WHENEVER POSSIBLE. WITH ITS COLLABORATORS, THE INSTITUTE CONTINUED TO INCREASE THE EVIDENCE BASE IN SUPPORT OF GEDS AS WELL AS THE NUMBER OF SENIOR-FRIENDLY EDS THROUGH THE NATIONAL ACCREDITATION PROGRAM. BY THE END OF 2019, THERE WERE MORE THAN 100 ACCREDITED GEDS ACROSS THE COUNTRY. ADDITIONALLY, THE INSTITUTE ALSO EXPANDED EFFORTS TO ADVANCE HOME AND COMMUNITY-BASED ACUTE CARE ALTERNATIVES, ESPECIALLY WITHIN THE CONTEXT OF RISK-BEARING PROVIDER AND DELIVERY SYSTEMS, ALL OF WHOM HAVE EMBRACED THE IMPERATIVE OF SHIFTING FROM A VOLUME TO VALUE-BASED PAYMENT MODEL. TAKEN TOGETHER, THE INSTITUTE REMAINS 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, ULTIMATELY TACKLING THE PRESSING NEED TO DIRECTLY ADDRESS THE COST OF HEALTHCARE. GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC) THE INSTITUTE HAS PARTNERED WITH THE JOHN A. HARTFORD FOUNDATION (JAHF) TO ESTABLISH A NATIONAL COLLABORATIVE OF LEADING GERIATRIC EMERGENCY MEDICINE PROGRAMS TO PROVIDE EARLY EVIDENCE THAT GED GUIDELINE-BASED CARE IMPROVES PATIENT OUTCOMES AND IS COST EFFECTIVE. THIS PAST YEAR, THE GEDC PROVIDED WORKFORCE TRAINING AT 6 TRAINING CONFERENCES ORGANIZED BY GEDC FACULTY. THESE INCLUDED EVENTS FOR HOSPITAL STAFF AT EMORY, ADVOCATE-AURORA SITES, MAYO CLINIC, UNIVERSITY OF CALIFORNIA SITES AND DARTMOUTH HEALTH SYSTEM. ADDITIONALLY, GEDC RESEARCHERS GENERATED EARLY EVIDENCE DEMONSTRATING THAT A GED NURSE INTERVENTION WAS ASSOCIATED WITH REDUCED RISK OF HOSPITAL ADMISSION AT BOTH INITIAL ED VISIT AND 30 DAYS POST ENCOUNTER. GEDC RESEARCHERS ALSO FOUND THAT TARGETED EVALUATION BY ED SOCIAL WORKERS FOR OLDER PATIENTS IS ASSOCIATED WITH REDUCED MEDICARE EXPENDITURES AT 30- AND 60-DAYS POST ED VISIT. THESE RESULTS HAVE BEEN PRESENTED AT NATIONAL CONFERENCES AND PUBLISHED IN SCIENTIFIC JOURNALS. IN COLLABORATION WITH THE INSTITUTE'S DATA SCIENCE TEAM, THE GEDC HAS COMPLETED A BUILD OF A NATIONAL RESEARCH DATA WAREHOUSE FOR CLINICAL RESEARCH AND BENCHMARKING PURPOSES. IN 2019, 3 PILOT SITES EXECUTED AGREEMENTS TO SHARE DATA WITH WHI AND 2 SITES HAVE ALREADY SHARED DATA AND ARE ABLE TO ACCESS THE PLATFORM. THE 3RD PILOT SITE HAS SENT OVER PARTIAL DATA AND IN JANUARY OF 2020 IS SCHEDULED TO SEND OVER REMAINING DATA ELEMENTS. IN 2019, A PARALLEL RESEARCH PROJECT LEVERAGING THE GEDC RESEARCH DATA WAREHOUSE WAS FUNDED BY THE NATIONAL INSTITUTE ON AGING (NIA) INCLUDING AN OCTOBER OF 2019 CONSENSUS CONFERENCE TO OUTLINE KEY FOCUS AREAS OF GED RESEARCH. FOCUS AREAS INCLUDE: COGNITIVE IMPAIRMENT, CARE TRANSITIONS, MOBILITY, MEDICATION MANAGEMENT AND ELDER ABUSE. THE GERIATRIC EMERGENCY CARE APPLIED RESEARCH (GEAR) NETWORK SEEKS TO SUPPLEMENT THE GEDC RESEARCH DATA WAREHOUSE WORK BY HELPING ESTABLISH A STANDARD SET OF CRITERIA FOR DATA COLLECTION IN AREAS RELATED TO GED. GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION (GEDA) PROGRAM WITH ONGOING FUNDING AND DIRECT COLLABORATIVE SUPPORT FROM WHI, THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS LAUNCHED THE GEDA PROGRAM TO STANDARDIZE SENIOR-FRIENDLY EMERGENCY CARE ACROSS HETEROGENEOUS SETTINGS AND FORMALLY ACCREDIT SITES BASED ON MEASURABLE CRITERIA. (AS WITH THE ABOVE GEDC WORKSTREAM, FUNDING SUPPORT IS ALSO PROVIDED BY THE JOHN A. HARTFORD FOUNDATION; BOTH WHI AND JAHF CLOSELY COORDINATE THEIR EFFORTS TO ENSURE MAXIMAL IMPACT AND NO OVERLAP/REDUNDANCY OF FUNDING.) TO DATE, OVER 150 EDS HAVE BEEN ACCREDITED ACROSS THREE LEVELS OF ACCREDITATION, INCLUDING THE GARY AND MARY WEST EMERGENCY DEPARTMENT AT THE UNIVERSITY OF CALIFORNIA SAN DIEGO HEALTH SYSTEM WHICH EARNED THE HIGHEST LEVEL OF ACCREDITATION (LEVEL 1). AN ADDITIONAL 36 EDS HAVE SUBMITTED APPLICATIONS THAT ARE CURRENTLY UNDER REVIEW BY THE BOARD OF GOVERNORS. ANOTHER 225 EDS ARE ON THE INTEREST LIST (E.G., CONSIDERING OR PREPARING AN APPLICATION). LEARNING AND ACTION NETWORK (LAN) TO MORE DIRECTLY ALIGN INSTITUTE RESEARCH WITH HEALTH SYSTEMS AND PROVIDERS THAT ARE PROACTIVELY MOVING AWAY FROM THE TRADITIONAL MEDICARE FEE-FOR-SERVICE (FFS) PAYMENT MODE (WHICH HAS POORLY ALIGNED INCENTIVES TO REDUCE VOLUME AND OVERALL COSTS), IN 2019, THE INSTITUTE WRAPPED UP COLLABORATIONS WITH SIX ACCOUNTABLE CARE ORGANIZATIONS (ACOS), FIVE HOSPITAL-BASED AND ONE PHYSICIAN-OWNED. RECOGNIZING THAT THE MOST EXPENSIVE CARE PROVIDED BY THESE ORGANIZATIONS IS ASSOCIATED WITH UNPLANNED ACUTE CARE NEEDS, THE LAN PARTICIPANTS DEVELOPED AND TESTED INNOVATIONS DESIGNED TO EFFECTIVELY ANTICIPATE AND RESPOND TO PREPARING FOR SERVING THE ACUTE CARE NEEDS OF OLDER ADULTS. THE ACOS PARTICIPATING IN THE INSTITUTE'S LAN REPRESENTED ADOPTERS OF THE MOST AGGRESSIVE DUAL-SIDED RISK MODEL KNOWN AS NEXT GENERATION ACOS. SERVING THE MEDICARE POPULATION, THESE ACOS ARE CONTRACTUALLY-BOUND TO WRITE CHECKS BACK TO MEDICARE IF THEY FAIL TO DIRECTLY SAVE MEDICARE DOLLARS, COMPARED TO BASELINES AND RISK SCORES DIRECTLY DERIVED FROM THE FEE-FOR-SERVICE (FFS) HISTORICAL COST BASIS. AS SUCH, THE INSTITUTE'S LAN DIRECTLY ENGAGED WITH SYSTEMS THAT WERE WILLING TO ACCEPT TRUE FINANCIAL RISK AND RESPONSIBILITY FOR SHEDDING THE LEGACY OF TRADITIONAL FFS MEDICARE. FOCUSING ON UNPLANNED ACUTE EVENTS, FOUR OF THE LAN'S ACOS DEVELOPED MODELS TO PROVIDE HOME-BASED ACUTE CARE IN THE HOME, WHILE TWO OTHERS FOCUSED ON INNOVATIVE EFFORTS IN THE ED AND SKILLED NURSING FACILITIES (SNF). CONSISTENT WITH THE FOCUS ON COSTLY ACUTE EPISODES OF CARE, ALL SIX ACOS PURSUED CARE DELIVERY INNOVATIONS DESIGNED TO AVOID HOSPITALIZATIONS AND FUTURE ED VISITS IN THEIR POPULATIONS OF FOCUS. IN 2019, THE INSTITUTE EXPANDED THE LAN AS WE GREW THESE ORGANIZATIONS' ABILITY TO PROVIDE BETTER CARE AT A LOWER COST. SPECIFICALLY, WITH ONGOING ENGAGEMENT FROM THE INSTITUTE FOR HEALTHCARE IMPROVEMENT (IHI), THE INSTITUTE EXPANDED THE LAN AND THE COLLABORATION WITH IHI TO INCLUDE 13 TEAMS FROM 12 LARGELY HOSPITAL-BASED HEALTHCARE ORGANIZATIONS FOR 12 MONTHS OF TESTING HOME-BASED ACUTE CARE INNOVATIONS. THE FOCUS OF THE HOME-BASED ACUTE CARE LEARNING AND ACTION NETWORK (HOMELAN) IS FOR THESE ORGANIZATIONS TO DELIVER SUSTAINABLE, VALUE-BASED CARE THROUGH INNOVATIONS IN BOTH THE PREPARATION AND RESPONSE TO UNPLANNED ACUTE EVENTS, ULTIMATELY REDUCING HOSPITALIZATIONS, ED VISITS AND ENABLING SENIORS TO REMAIN IN THEIR CHOSEN HOMES AND COMMUNITY SETTINGS. TO SUPPORT NATIONWIDE ADOPTION AND SPREAD OF THESE INNOVATIONS, LEARNINGS, OUTCOMES AND BEST PRACTICES DERIVED FROM BOTH THE 2018 AND THE EXPANDED 2019 HOMELAN WILL BE ACTIVELY DEVELOPED AND SHARED WITH THE BROADER COMMUNITY. SPECIFICALLY, THROUGH THESE COLLABORATIONS, CHANGE MANAGEMENT TOOLKITS WILL BE DEVELOPED AND SHARED WITH THE MEMBERS OF THE IHI, THE NATIONAL ASSOCIATION OF ACOS, IAC, CMS, THE CENTER FOR MEDICARE & MEDICAID INNOVATIONS (CMMI) AND OTHERS THROUGH WORKSHOPS, WEBINARS, AND RESEARCH PUBLICATIONS. AS A COMPLEMENT TO THIS HOMELAN WORKSTREAM, THE INSTITUTE COLLABORATED WITH THE INSTITUTE FOR ACCOUNTABLE CARE (IAC) TO CARRY OUT A NATIONAL SURVEY TO BROADLY CHARACTERIZE HOME-BASED CARE INNOVATIONS WITHIN THE ACCOUNTABLE CARE COMMUNITY. THIS WILL ALLOW ADDITIONAL NUANCE AND TARGETING OF THE DISSEMINATION EFFORTS ABOVE AS WELL AS PROVIDE GUIDANCE FOR FURTHER EVOLUTION OF THIS IMPORTANT WORK.
FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICES	EXPANSION OF GEDS TO RURAL AREAS (VIA TELEHEALTH) IN 2019, WEST HEALTH INSTITUTE LAUNCHED A NOVEL PARTNERSHIP WITH DARTMOUTH-HITCHCOCK HEALTH TO DEVELOP A RURAL HUB-AND-SPOKE TELEHEALTH MODEL OF GERIATRIC EMERGENCY CARE THAT WILL BENEFIT SENIORS ACROSS NORTHERN NEW ENGLAND AND SERVE AS A TEMPLATE FOR EXPANSION OF GEDS TO RURAL AREAS ACROSS THE US (AN AREA OF HIGH NEED). THE PROJECT OFFICIALLY LAUNCHED WITH FULL CONTRACT EXECUTION BEING COMPLETED IN SEPTEMBER 2019, FOLLOWED BY A FORMAL PRESS RELEASE IN OCTOBER 2019. THE FIRST STAGE OF THIS THREE-YEAR PROJECT FOCUSES ON TRAINING AND ACCREDITATION OF THE MAIN DARTMOUTH-HITCHCOCK MEDICAL CENTER (DHMC) HOSPITAL, WHICH WILL SERVE AS THE HUB SITE FOR THE HUB-AND-SPOKE MODEL. AN IMPORTANT MILESTONE IN ESTABLISHING THE DHMC GED WAS ACHIEVED IN OCTOBER 2019, WHEN DHMC AND THE GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC) CO-FACILITATED A GED BOOTCAMP TRAINING FOR KEY DHMC STAFF INVOLVED IN GED IMPLEMENTATION, SERVING AS AN OFFICIAL "KICK-OFF" FOR THE PROJECT. CONCURRENT WITH THE BOOTCAMP ACTIVITIES, DHMC HOSTED A WEBINAR WITH NUMEROUS RURAL HEALTH CENTERS IN THE REGION TO BUILD AWARENESS AND INTEREST AROUND THE OPPORTUNITY TO PARTICIPATE AS SPOKE SITES IN THE FUTURE. THE DIRECTOR OF TELEHEALTH ALSO VISITED TWO POTENTIAL RURAL SPOKE SITES WHO PARTICIPATED IN THE WEBINAR TO DISCUSS THE OPPORTUNITY AND INFORMALLY ASSESS OPERATIONAL READINESS. SINCE THE BOOTCAMP, DHMC HAS BEEN WORKING TO IMPLEMENT A RANGE OF NEW AND REVISED GED WORKFLOWS AND PROTOCOLS, AS WELL AS PURSUING A QUALITY IMPROVEMENT PROJECT UNDER THE GUIDANCE OF GEDC FACULTY. DHMC WILL "GO LIVE" AS A GED WITH ITS FIRST GED PATIENT CONSULTATION IN JANUARY 2020. ONSITE ACUTE CARE FOR SENIORS IN SKILLED NURSING FACILITIES (BETH ISRAEL DEACONESS MEDICAL CENTER AND CALL9) IN 2018, THE INSTITUTE LAUNCHED A COLLABORATION WITH BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) AND A TECHNOLOGY-ENABLED HEALTH PROVIDER THAT WHICH PROVIDES ON-SITE ACUTE CARE TO SENIORS IN SKILLED NURSING FACILITIES (SNFS). THIS SNF-BASED INNOVATION HAS THE POTENTIAL TO REDUCE COSTS WHILE EXPANDING MORE OPTIONS FOR PROVIDING BETTER CARE IN THE COMMUNITY SETTING. SPECIFICALLY, BY EXTENDING THE INSTITUTE'S VISION OF PROACTIVE CARE IN PLACE TO THE NURSING HOME SETTING, THIS COLLABORATION EMBRACED SOME OF THE MOST VULNERABLE SENIORS AND PROVIDED NEW OPTIONS WHERE APPROPRIATE TO AVOID DIFFICULT ED TRANSFERS AND HOSPITAL ADMISSIONS. WORKING WITHIN THE NURSING HOME SETTING, EMERGENCY PHYSICIANS PROVIDED ANTICIPATORY FOUNDATIONS FOR BETTER ACUTE CARE RESPONSES BY PLACING ITS OWN EMERGENCY MEDICAL TECHNICIANS (EMTS) STAFF DIRECTLY ON-SITE. OPERATING WITH THE SUPPORT OF A CLOUD-BASED TELEHEALTH PLATFORM AND AN ON-SITE MOBILE EMERGENCY KIT, COMPRISED OF AN EKG, ULTRASOUND, ISTAT (LABS) AND OTHER EQUIPMENT, THE MODEL ALLOWED ON-SITE STAFF TO RECOGNIZE AND INITIATE A MORE AGILE RESPONSE TO NASCENT UNPLANNED ACUTE EVENTS, SPECIFICALLY PROVIDING NEAR REAL-TIME ACCESS TO REACH AN EMERGENCY DOCTOR AS AN ALTERNATIVE TO CALLING 911. WORKING TOGETHER WITH BIDMC, WHI CONDUCTED A COMPREHENSIVE EVALUATION OF THE SNF-BASED PROGRAM'S OUTCOMES, INCLUDING PROCESS-BASED OUTCOMES (E.G., REDUCED ED AND HOSPITAL UTILIZATION, AS WELL AS ECONOMIC IMPACT). RESULTS SUGGESTED THAT THE REDUCTION OF ED VISITS AND HOSPITAL ADMISSIONS OFFERED A SIGNIFICANT SAVINGS OVER THE TRADITIONAL CARE PATHWAYS. IN 2019, COMPREHENSIVE RESULTS OF THE BIDMC/CALL9 STUDY WERE ANALYZED AND INCORPORATED INTO THE ONGOING PORTFOLIO OF INSTITUTE RESOURCES DESIGNED TO DRIVE CHANGES IN THE MANAGEMENT OF ACUTE UNPLANNED CARE, ULTIMATELY SHIFTING AS MUCH OF THAT CARE TOWARD THE HOME AND COMMUNITY SETTING. THIS RESEARCH WAS AN IMPORTANT DIMENSION IN ADDRESSING SENIORS' NEEDS PROACTIVELY TO PREVENT AN ED VISIT OR HOSPITALIZATION, REDUCING THE HIGH COST OF ACUTE CARE. VALUE-BASED ORGANIZATIONS ARE NOW LOOKING TO PARTNER WITH SNFS TO OFFER SENIORS THE OPPORTUNITY TO RECEIVE HIGH-QUALITY CARE IN PLACE WHILE LOWERING COSTS. RESULTS CONTINUE TO INFORM THE BUSINESS CASE FOR AT-RISK ORGANIZATIONS TO COLLABORATE MORE EFFECTIVELY WITH POST-ACUTE PROVIDERS TO DRIVE VALUE-BASED CARE. MOUNT SINAI: 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 IN MANY CASES 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, USING CENTER FOR MEDICARE & MEDICAID INNOVATION FUNDING, 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 DELIVERING 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 AND CONTINUING IN 2019, THE INSTITUTE COLLABORATED WITH MOUNT SINAI 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 ARE AIDING IN 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 FFS REIMBURSEMENT. WHILE NUMEROUS HEALTH SYSTEMS RECOGNIZE AND EMBRACE THE OVERALL TRANSITION FROM VOLUME TO VALUE-BASED CARE, THEY GENERALLY OPERATE AT MARGINS THAT PRECLUDE EXTENSIVE INVESTMENT IN NON-REIMBURSABLE SERVICES, DESPITE THE POTENTIAL FOR FUTURE RETURNS. IMPORTANTLY, FINDINGS FROM THE STUDY PROVIDED CLARITY TO 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. DELIRIUM RESOURCES FOR THE EMERGENCY DEPARTMENT DELIRIUM REMAINS A SIGNIFICANT ISSUE FOR SENIORS ACROSS MANY CARE SETTINGS. THE CONDITION, A SIGN OF A VARIETY OF ACUTE MEDICAL ISSUES (AND SOMETIMES THE ONLY SIGN) IS ASSOCIATED WITH ELEVATED MORBIDITY AND MORTALITY YET IS OFTEN MISSED IN THE ED. IN JULY 2019, WEST HEALTH INSTITUTE AND THE INSTITUTE FOR AGING RESEARCH, AN AFFILIATE OF HARVARD SCHOOL OF MEDICINE, COMPLETED A DELIRIUM TOOLKIT FOR THE DETECTION, MANAGEMENT, AND TREATMENT OF DELIRIUM IN THE ED. THE DRAFT TOOLKIT WAS DISSEMINATED FOR FEEDBACK AT AN EXPERT WORKGROUP MEETING COMPRISED OF LEADING EXPERTS IN DELIRIUM MANAGEMENT AND EMERGENCY MEDICINE AND A REVISED VERSION OF THE TOOLKIT WAS COMPLETED IN DECEMBER 2019. TELEHEALTH HEALTHCARE ORGANIZATIONS ARE STRUGGLING TO KEEP UP WITH THE INCREASING DEMAND OF THE SENIOR POPULATION. THE PROVIDER POPULATION IS DWINDLING, AND THE SENIOR POPULATION IS GROWING AT A RATE THAT HAS NOT BEEN EXPERIENCED BY OUR COUNTRY. OUR HEALTHCARE SYSTEM IS SLOW TO RESPOND TO THIS NEED. THE CREATION OF CARE DELIVERY MODELS THAT WILL ALLOW FOR BETTER OUTCOMES, DECREASED COSTS AND INCREASED ACCESS FOR A POPULATION THAT IS LIVING LONGER WITH MORE COMORBIDITIES IS IMPERATIVE. TELEHEALTH HAS BEEN SHOWN TO IMPROVE ACCESS AND HEALTH OUTCOMES AND DECREASE COST, YET MANY ORGANIZATIONS STRUGGLE TO UNDERSTAND THE OPPORTUNITY AND HOW TO MOVE FORWARD. TO ADDRESS THIS, WEST HEALTH INSTITUTE HAS CREATED AND IMPLEMENTED TOOLS AND EDUCATIONAL PROGRAMS THAT ORGANIZATIONS CAN ATTEND OR USE TODAY. TO DATE, THE INSTITUTE HAS BECOME A LEADER IN PROLIFERATING KNOWLEDGE AND EXPANDING TELEHEALTH ADOPTION IN SENIOR-SPECIFIC CARE MODELS THAT CONTRIBUTE TO AND PROMOTE IMPROVED OUTCOMES AND SUCCESSFUL AGING. RESEARCH MILESTONES IN 2019 INCLUDE: * COMPLETION OF A FIRST-OF-ITS-KIND TELEHEALTH IMPLEMENTATION MANUAL IN COLLABORATION WITH 13 NATIONALLY-RECOGNIZED LEADERS IN TELEHEALTH AND POST-ACUTE AND LONG-TERM CARE ACROSS 10 ORGANIZATIONS.
FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICES	* COMPLETION OF A PRACTICE GUIDE TO INFORM HOME-BASED PRIMARY CARE USING TELEHEALTH ALONG WITH CREATING A DISSEMINATION STRATEGY TO TARGETED FORUMS. * DISSEMINATION OF THE MANUAL VIA A MULTITUDE OF FORUMS INCLUDING, BUT NOT LIMITED TO RESEARCH CONFERENCES AND WORKSHOPS IN CONJUNCTION WITH MAJOR ORGANIZATIONS SUCH AS THE SOCIETY FOR POST-ACUTE AND LONG-TERM CARE (AMDA), THE AMERICAN TELEMEDICINE ASSOCIATION (ATA) AND THE AMERICAN GERIATRICS SOCIETY (AGS) AS WELL AS A WORKSHOP HOSTED AT THE INSTITUTE. * COMPLETION OF THE FIRST-EVER, MULTI-ORGANIZATIONAL (I.E., KAISER PERMANENTE, THOMAS JEFFERSON UNIVERSITY AND SPECTRUM HEALTH) TELEHEALTH RESEARCH PROJECT AND DRAFT MANUSCRIPT TO DEMONSTRATE THE CLINICAL IMPACT ON OUTCOMES AND COST TO ADDRESS ACUTE URGENT CONDITIONS FOR SENIORS. * GUIDING AND INFORMING THE DEVELOPMENT OF A TELEHEALTH PROGRAM "STARTER KIT" INCLUDING 15 DOWNLOADABLE RESOURCES AND 5 PODCASTS TO ADDRESS THE NEEDS OF SENIORS IN SENIOR LIVING COMMUNITIES. ADVANCING SENIOR-APPROPRIATE CHRONIC CARE MODELS 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. CREATING AND IMPROVING SYSTEMS OF CHRONIC CARE THAT PLACE OLDER ADULTS AND WHAT MATTERS TO THEM AT THE CENTER OF CARE MODELS IS ESSENTIAL TO ALLOWING SENIORS TO AGE AS INDEPENDENTLY AS POSSIBLE AND PRESERVE AND SUPPORT THEIR QUALITY OF LIFE. HOME-BASED PRIMARY CARE - CREATING A QUALIFIED CLINICAL DATA REGISTRY (QCDR) 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-DELIVERED 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. 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. SINCE 2016, THE INSTITUTE HAS CONTINUED TO COLLABORATE WITH OUR RESEARCH PARTNERS TO DEVELOP THE E-SPECIFICATIONS FOR THE CUSTOM QUALITY MEASURES. TO DATE, THE REGISTRY HAS RECEIVED DATA FROM OVER 500 PROVIDERS CARING FOR MORE THAN 50,000 PATIENTS NATIONWIDE, ALLOWING PROVIDERS TO TRACK PERFORMANCE AGAINST NATIONAL BENCHMARKS AND CLOSE GAPS IN PATIENT CARE. IN 2019, THE QCDR BECAME THE CORNERSTONE OF THE NATIONAL HOME-BASED PRIMARY AND PALLIATIVE CARE CONSORTIUM LEARNING COLLABORATIVE OF NINE ADDITIONAL PROVIDER PRACTICES THAT ARE NOW CONTRIBUTING DATA TO THE REGISTRY. THE REGISTRY WAS SUCCESSFULLY REAPPROVED AS A QCDR BY CMS FOR 2020. NORTHWELL HEALTH - HOME-BASED MONITORING IN APRIL 2017, THE INSTITUTE LAUNCHED A FOUR-YEAR RESEARCH PROJECT WITH NORTHWELL HEALTH'S HOUSE CALLS PROGRAM, "HOME-BASED MONITORING TO ENHANCE AND SCALE A HIGH-TOUCH HOME-BASED PRIMARY CARE PROGRAM." NORTHWELL HEALTH IS A LARGE, MULTIHOSPITAL SYSTEM THAT IS NEW YORK'S LARGEST HEALTH PROVIDER. THE RESEARCH AIMS TO EXPAND THE PATIENT CENSUS IN THE HOUSE CALLS PRACTICE OVER A FOUR-YEAR PERIOD THROUGH REDESIGN OF THE SCHEDULED IN-HOME VISITS USING DIFFERENT CARE TEAM COMPOSITION AND TELEHEALTH TECHNOLOGY. IN 2017, 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. BASED ON THESE INTERVIEWS, THE TEAM ENGAGED IN OBSERVATIONS OF STAFF WORKFLOWS TO IDENTIFY INEFFICIENCIES AND DEVELOP A PLAN TO ALLEVIATE THESE INEFFICIENCIES. IN 2018, THE TEAM MODELED THE FINANCES OF THE PRACTICE AND IDENTIFIED KEY LEVERS TO REDUCE COSTS AND INCREASE REVENUE WHILE MAINTAINING HIGH-QUALITY CARE. ADDITIONALLY, THE TEAM IMPLEMENTED STRATEGIES TO STREAMLINE OPERATIONS (E.G., FIRST CALL RESOLUTION, STANDARDIZING CARE TEAM MEMBER TRIAGE WHEN RESPONDING TO CHANGE IN CONDITION AND ACUITY LEVEL ANALYSIS) AND PILOTED VIDEO VISITS WITH 25 PATIENTS AND THEIR PROVIDERS. IN 2019, THIS PROCESS IMPROVEMENT WORK CONTINUED BY TESTING VIDEO VISITS TO EXTEND THE REACH OF THE PRIMARY CARE PROVIDER TO MORE PATIENTS BY USING TELEHEALTH AND EMERGENCY MEDICAL TECHNICIANS (EMTS) AS "PHYSICIAN EXTENDERS." THIS CARE MODEL HAS INCREASED THE NUMBER OF PATIENT VISITS HOUSE CALLS PHYSICIANS CAN CARE FOR EACH DAY WHILE ALSO INCREASING OPERATIONAL CAPACITY TO RESPOND TO ACUTE EXACERBATIONS OF SYMPTOMS IN PATIENTS. IN 2019, THE INSTITUTE ALSO DEVELOPED AND PUBLISHED "A PRACTICAL GUIDE TO EXPANDING HOME-BASED PRIMARY CARE WITH TELEHEALTH." THE GUIDE WAS DESIGNED TO SUPPORT ANY HOME-BASED CARE PRACTICE THAT SEEKS TO ADOPT TELEHEALTH TO INCREASE THE NUMBER OF SENIORS IN ITS PRACTICE. 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 THE ALZHEIMER'S ASSOCIATION'S 2018 REPORT, MORE THAN 16 MILLION FAMILY CAREGIVERS PROVIDE UNPAID CARE TO PEOPLE WITH ALZHEIMER'S OR OTHER DEMENTIAS, AND THAT NUMBER IS EXPECTED TO INCREASE AS BABY BOOMERS AGE. DEMENTIA CAREGIVERS PROVIDE CARE FOR LONGER TIME PERIODS THAN OTHER CAREGIVERS, WITH 57% CARING FOR A LOVED ONE FOR FOUR OR MORE YEARS. DESPITE THE COMPLEXITY OF PROVIDING THIS TYPE OF CARE, THERE IS LITTLE COORDINATION BETWEEN CAREGIVERS AND THE FORMAL HEALTHCARE INFRASTRUCTURE. THE INSTITUTE HAS EXPLORED AND RESEARCHED 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. 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. FAMILY CAREGIVERS WERE NOT USING ONLINE RESOURCES. FOR EXAMPLE, ONLINE RESOURCES THAT DO EXIST HAVE LOW ATTENDANCE, SUGGESTING LIMITED SUCCESS IN REACHING FAMILY CAREGIVERS AT SCALE. GIVEN 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. CAPC AND WHI WORKED WITH NATIONAL LEADERS IN DEMENTIA CARE TO EASE THE BARRIERS TO DEMENTIA CARE BY DEVELOPING TRAINING FOR ALL PROVIDERS WHO ENCOUNTER PEOPLE WITH COGNITIVE IMPAIRMENT AND THEIR CAREGIVERS. TRAINING INCLUDES ONLINE CLINICAL COURSES IN THE SKILLS NEEDED TO DISCLOSE A DEMENTIA DIAGNOSIS TO PATIENTS, ASSESSING AND ALLEVIATING CAREGIVER BURDEN, COMMUNICATING ABOUT WHAT TO EXPECT AS DEMENTIA PROGRESSES, AND INTERPRETING AND ADDRESSING BEHAVIORAL SYMPTOMS OF DEMENTIA. THE NEW CURRICULUM, BEST PRACTICES IN DEMENTIA CARE AND CAREGIVER SUPPORT, AND THE FIRST THREE OF SEVEN COURSES WERE RELEASED IN AUGUST 2018. AS OF FEBRUARY 2019, OVER 1,400 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.
FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICES	* CONCEPTION OF "GOTLC.ORG" THE FIRST ALL-INCLUSIVE, OPEN-ACCESS INFORMATION CHANNEL FOR GUIDING AND INFORMATIVE RESOURCES FOR THE DEVELOPMENT OF TELEHEALTH PROGRAMS FOR SENIOR-SPECIFIC CARE ALONG WITH THE CREATION OF A "STARTER KIT" TO HELP SENIOR CARE COMMUNITIES JUMP START THEIR TELEHEALTH PROGRAMS WITH A NEEDS-FOCUSED PERSPECTIVE. * DISSEMINATION OF KNOWLEDGE GAINED FROM A TELEHEALTH DEMONSTRATION PROJECT IN ASSISTE WORK IN THIS IMPORTANT AREA CONTINUED IN 2019, DURING WHICH FOUR ADDITIONAL COURSES WERE RELEASED: * "PLANNING FOR THE FUTURE WITH PEOPLE LIVING WITH DEMENTIA AND THEIR CAREGIVERS" * "SUPPORTING THE CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA" * "MOOD AND SLEEP DISTURBANCES IN PEOPLE LIVING WITH DEMENTIA" * "CRITICAL DECISIONS IN ADVANCED DEMENTIA" ADDITIONALLY, A TOOLKIT ENTITLED, "IMPROVING DEMENTIA CARE" WAS RELEASED IN APRIL OF 2019. THE TOOLKIT OUTLINES KEY OPERATIONAL PROCESSES HEALTHCARE PROFESSIONALS AND HEALTH SYSTEMS CAN IMPLEMENT TO BETTER SUPPORT CAREGIVERS. 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. IN ADDITION TO APPROPRIATELY PLACING THE PATIENT AT THE CENTER OF THE CARE PARADIGM, PALLIATIVE CARE ALSO REPRESENTS A ROUTE TO BETTER DEPLOYMENT OF HEALTHCARE DOLLARS AND REDUCING OVERALL COST TO THE US HEALTH SYSTEM. IN THE COMMUNITY, PALLIATIVE CARE HAS FACED MORE BARRIERS TO EXPANSION AND, AS SUCH, HAS BEEN SLOWER TO REACH THE POPULATION IN NEED. THE INSTITUTE'S GOAL IS TO SPUR ADOPTION OF HOME AND COMMUNITY-BASED PALLIATIVE CARE PROGRAMS FOR SENIORS WITH SERIOUS ILLNESS AND IT IS CONDUCTING THREE MAJOR RESEARCH PROJECTS THAT AIM TO ADDRESS THIS GOAL. PROJECT HOPE - HOME-BASED PALLIATIVE CARE IN 2016, THE INSTITUTE LAUNCHED A MULTI-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. AS PART OF THIS WORK, THE INSTITUTE IS INTERESTED IN FURTHER DISSEMINATION OF THE COMMUNITY-BASED PALLIATIVE CARE MODEL AND THE RESEARCH TEAM HAS BEGUN WORK ON DEVELOPING A 'PLAYBOOK' THAT OUTLINES HOW HEALTH SYSTEMS CAN ADOPT THIS MODEL WITHIN THEIR SYSTEM. IN 2018, THE TEAM TRAINED THE CLINICAL STAFF FOR IMPLEMENTING THE PALLIATIVE PROGRAM AND PILOTED THE HOME-BASED PALLIATIVE CARE MODEL WITH TEN SENIORS. THE RANDOMIZED CONTROLLED TRIAL TO EVALUATE THE PROGRAM COMPARED TO A USUAL CARE CONTROL GROUP WAS LAUNCHED IN AUGUST OF 2018. IN 2019, MORE THAN 180 SENIORS WERE ENROLLED IN THE PROGRAM. BLUE SHIELD HOME-BASED PALLIATIVE CARE EVALUATION AND DISSEMINATION 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 DRIVE THE DISSEMINATION OF THIS PROGRAM TO OTHER HEALTHCARE PAYERS, THE INSTITUTE WILL EVALUATE THE COST-SAVINGS OF THE PROGRAM RELATIVE TO THE COST OF DELIVERING THE PROGRAM. IN 2019, THE INSTITUTE SUCCESSFULLY ACQUIRED THE BLUE SHIELD DATA, DEVELOPED THE PROPENSITY MATCHING ALGORITHM, AND COMPLETED SEVERAL STAGES OF DATA ANALYSIS TO PREPARE FOR THE FINAL RETURN ON INVESTMENT CALCULATIONS. THE INSTITUTE ALSO FACILITATED 6 VIRTUAL MEETINGS INCLUDING 25+ BLUES-AFFILIATED HEALTH PLANS ACROSS THE COUNTRY. THIS BLUES SERIOUS ILLNESS WORKGROUP WILL SERVE AS A DISSEMINATION VEHICLE FOR THE RESEARCH FINDINGS THROUGH 2020. CAPC HEALTH PLAN, ACO, AND PACE LEARNING COMMUNITY PROJECT IN MAY 2019, WHI PARTNERED WITH CAPC, ALONG WITH A GROUP OF CO-FUNDERS CONSISTING OF COMMONWEALTH FUND, PETERSON CENTER ON HEALTHCARE, AND THE JOHN A. HARTFORD FOUNDATION (JAHF), AND BEGAN A THREE-YEAR LEARNING COMMUNITY PROJECT AIMED AT EXPANDING PALLIATIVE CARE SERVICES WITH 22 HEALTH INSURANCE PLANS AND 18 ACOS. IN ADDITION, THE INSTITUTE IS CO-LEADING A LEARNING COMMUNITY ON PALLIATIVE CARE FOCUSED ON PACE PROGRAMS. ACTIVITIES OF THE LEARNING COMMUNITY INCLUDE CONVENING MEDICARE ADVANTAGE (MA) PLANS, ACOS, AND PACE PROGRAMS AND PROVIDING ACCESS TO EXPERTS AND TECHNICAL ASSISTANCE TO EXPEDITE THE DISSEMINATION OF PALLIATIVE CARE STRATEGIES. THE PARTICIPATING HEALTH PLANS AND ACOS WILL IMPLEMENT AT LEAST ONE OF FOUR STRATEGIES: CASE MANAGER SKILL BUILDING, PROACTIVE BENEFICIARY IDENTIFICATION, DEVELOPMENT OF HOME-BASED PALLIATIVE CARE SERVICES, OR CREATION OF NETWORK STANDARDS AND INCENTIVES. THE OUTCOME OF THE PACE LEARNING COMMUNITY WILL BE ENHANCED PALLIATIVE CARE STRATEGIES RELATED TO INTERDISCIPLINARY TEAM TRAINING, PROACTIVE IDENTIFICATION OF PARTICIPANTS, AND DEVELOPING QUALITY METRIC PROGRAMS. TO MOVE THIS WORK FORWARD, CAPC AND THE INSTITUTE LED TWO SUCCESSFUL KICK-OFF MEETINGS WITH PARTICIPATING MA PLANS AND ACOS IN CHICAGO AND WASHINGTON, DC. THE MA PLAN LEARNING COMMUNITY HELD ITS FIRST ROUND OF VIRTUAL OFFICE HOURS, VIRTUAL CONVENINGS, AND COACHING CONVERSATIONS. FOURTEEN PACE PROGRAMS APPLIED FOR THE PACE LEARNING COMMUNITY, REPRESENTING 20% OF ALL PACE PARTICIPANTS IN THE NATION. PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY ("PACE") THE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY PROVIDES WRAP-AROUND MEDICAL AND SOCIAL SERVICES FOR SENIORS WHO WOULD OTHERWISE NEED NURSING HOME LEVEL CARE. MANAGING THE CHRONIC CONDITIONS AND NEEDS OF THIS HIGH-COST, HIGH-NEED POPULATION SEGMENT REQUIRES COORDINATED CARE TO ENABLE AGING-IN-PLACE AT HOME. THE INSTITUTE IS WORKING CLOSELY WITH GARY AND MARY WEST PACE TO DEVELOP AND EXECUTE AN INNOVATIVE PROGRAM OF APPLIED MEDICAL RESEARCH STUDIES TO ENHANCE AND EXPAND THE SERVICE DELIVERY OF PACE FOR BOTH GMW PACE AS WELL AS PACE PROGRAMS NATIONALLY. THE INSTITUTE CONTINUES TO BE AN ACTIVE MEMBER OF AND WORK CLOSELY WITH THE CALIFORNIA PACE ASSOCIATION (CALPACE) AND NATIONAL PACE ASSOCIATION (NPA) IN ORDER TO ENSURE THAT THE RESEARCH AND LEARNINGS GARNERED FROM THE COLLABORATION WITH GMW PACE HAVE APPROPRIATE VECTORS FOR WIDESPREAD DISSEMINATION. IN 2019, THE INSTITUTE'S RESEARCH EFFORTS HAVE INCLUDED LAUNCHING PROJECTS TO SCREEN ALL NEW PACE PARTICIPANTS FOR MALNUTRITION, DEVELOPING PLANS TO INCLUDE TELEHEALTH WITHIN THE PRACTICE, AND PROVIDE RESPONSIVE CARE FOR ACUTE EVENTS THAT TAKE PLACE OUTSIDE OF THE CLINIC WITH THE OBJECTIVE OF REDUCING/AVOIDING UNNECESSARY VISITS TO THE EMERGENCY ROOM AND/OR HOSPITAL ADMISSIONS. ORAL HEALTHCARE 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 CONTINUES TO BE AN ACTIVE CONTRIBUTOR TO CALIFORNIA'S ORAL HEALTH NETWORK AS A MEMBER OF ITS POLICY COMMITTEE REPRESENTING THE VOICE OF SENIORS THROUGH STATE ORAL HEALTH POLICY AND ADVOCACY. 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 UTILIZED 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.
FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICES	ADDITIONALLY, THE INSTITUTE LEVERAGED THIS DATA 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. THE STUDY WAS COMPLETED IN 2019, RESULTS WERE SHOWCASED AT THE SPECIAL CARE DENTISTRY ASSOCIATION CONFERENCE, AND A MANUSCRIPT WAS WRITTEN AND PUBLISHED TO FURTHER ELABORATE ON THE ANALYSES CONDUCTED WITH THE ATD DATABASE. AGE-FRIENDLY DENTAL CARE GUIDELINES THE INSTITUTE PARTNERED AGAIN WITH THE INSTITUTE FOR HEALTHCARE IMPROVEMENT (IHI) TO CONDUCT A LANDSCAPE ANALYSIS TO IDENTIFY THE MOST PRESSING ISSUES WITH RESPECT TO QUALITY OF ORAL HEALTHCARE FOR SENIORS AT VARIOUS LEVELS FROM THE PAYMENT, POLICY, AND INDUSTRY LEVEL, FROM THE PERSPECTIVE OF THE PROVIDER ORGANIZATIONS TO THE PATIENT AND PUBLIC LEVEL. THROUGH THIS WORK, THE INSTITUTE EVALUATED THE ORAL HEALTH LANDSCAPE FOR OLDER ADULTS, IDENTIFIED OPPORTUNITIES TO IMPROVE QUALITY WITH A SPECIFIC FOCUS ON THE DIMENSIONS OF SAFETY, PATIENT-CENTEREDNESS, AND EQUITY, AND SURFACED EXEMPLARS AND PROMISING PRACTICES IN THE FIELD. A FINAL SET OF RECOMMENDATIONS WERE PRESENTED FOR CONSIDERATION FOR FUTURE OPPORTUNITIES RELATED TO AGE-FRIENDLY DENTAL CARE GUIDELINES. ADVANCING SUPPORTIVE SERVICES IN THE U.S., CLINICAL CARE IS ESTIMATED TO ACCOUNT FOR APPROXIMATELY 20 PERCENT OF HEALTH OUTCOMES. THE OTHER 80 PERCENT OF HEALTH CONTRIBUTORS ARE THE SOCIAL DETERMINANTS OF HEALTH (SDOH). SENIOR PROGRAMS AND SERVICES THAT ARE DELIVERED BY COMMUNITY-BASED ORGANIZATIONS ADDRESS SDOH. THESE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO NUTRITION EDUCATION AND SUPPORT, TRANSPORTATION, IN-HOME PERSONAL CARE, DISEASE MANAGEMENT, AND CARE TRANSITIONS. ADDRESSING THE SDOH HELPS REDUCE SOCIAL ISOLATION, IMPROVE HEALTH, LOWER HEALTHCARE COSTS AND ALLOW SENIORS ACROSS THE COUNTRY TO REMAIN HEALTHY AND INDEPENDENT IN THEIR HOMES AND COMMUNITIES FOR AS LONG AS POSSIBLE. IN RECOGNITION OF THE INCREASED DEMAND BY HEALTHCARE ORGANIZATIONS TO ADDRESS SDOH, THE INSTITUTE RESEARCHED NEW WAYS FOR COMMUNITY-BASED AND HEALTHCARE ORGANIZATIONS TO DELIVER MORE COORDINATED, SENIOR-APPROPRIATE CARE BY SCREENING FOR AND ADDRESSING THE SDOH. THESE EFFORTS REPRESENT AN IMPORTANT ASPECT OF THE INSTITUTE'S MODUS OPERANDI IN WHICH RESOURCES ARE DEPLOYED "TO LEARN" AS WELL AS "TO BUILD" ADDRESSING SDOH WILL BE AN IMPORTANT COMPONENT FOR SUCCESS IN MOST AREAS (SUCH AS GEDS, PACE, AND OTHER MODELS DESCRIBED ABOVE) WHERE THE INSTITUTE HAS CHOSEN TO DEEPLY FOCUS AND CONCENTRATE EFFORTS. MALNUTRITION EMPOWERING COMMUNITY BASED ORGANIZATIONS MALNUTRITION DISPROPORTIONALLY AFFECTS SENIORS, WITH UP TO ONE OUT OF TWO AT RISK FOR MALNUTRITION. TO ADDRESS THIS GROWING PUBLIC HEALTH CRISIS, THE INSTITUTE HOSTED A SENIOR MALNUTRITION VISIONING SESSION IN WASHINGTON D.C. IN FEBRUARY 2018. THE VISIONING SESSION ENGAGED NATIONAL LEADERS IN HEALTHCARE, AGING, SENIOR NUTRITION, POLICY AND RESEARCH TO EXCHANGE INNOVATIVE IDEAS THAT WOULD ADVANCE COMPREHENSIVE MALNUTRITION CARE AND PREVENTION THROUGH PRACTICE INNOVATIONS AND COMMUNITY-BASED SOLUTIONS. THE OUTPUT OF THE SESSION WAS A MULTI-YEAR ROADMAP THAT CHARTED A STRATEGY TO ACHIEVE COMPREHENSIVE SENIOR MALNUTRITION CARE THROUGH IDENTIFICATION, INTERVENTION, EVALUATION AND POLICY/REIMBURSEMENT REFORM. TO ADVANCE THE ROADMAP AND BECOME A CHANGE AGENT FOR REDUCING SENIOR MALNUTRITION, THE INSTITUTE PARTNERED WITH THE DEFEAT MALNUTRITION TODAY COALITION (DMT) IN 2019 AND ESTABLISHED A SUBGROUP THAT FOCUSED ON ACCELERATING THE ROLE OF COMMUNITY-BASED ORGANIZATIONS (CBOS) TO IDENTIFY AND ADDRESS THE SOCIAL RISK FACTORS ASSOCIATED WITH MALNUTRITION. CBOS HAVE BEEN PROVEN TO BE UNIQUELY POSITIONED TO ADVANCE MALNUTRITION CARE FOR COMMUNITY-DWELLING SENIORS BECAUSE THEY ARE DEEPLY ROOTED IN THEIR COMMUNITIES AND PROVIDE A WIDE ARRAY OF PROGRAMS AND SERVICES THAT ADDRESS UNMET SOCIAL NEEDS. LACK OF TRANSPORTATION, FOOD INSECURITY, POVERTY, SOCIAL ISOLATION, LIMITED ACCESS TO PUBLIC BENEFIT PROGRAMS, AND OTHER SUPPORT PROGRAMS AND SERVICES OFTEN CONTRIBUTE TO MALNUTRITION. IN 2019, THE INSTITUTE CONDUCTED A SERIES OF WEBINARS TO EDUCATE NUTRITION AND HEALTHCARE PROVIDERS ABOUT INNOVATIVE COMMUNITY-BASED PROGRAMS THAT ARE SCREENING SENIORS FOR MALNUTRITION AND ADDRESSING RELATED UNMET SOCIAL NEEDS. LEVERAGING MEALS ON WHEELS AMERICA TO ASSESS STATUS AND NEEDS 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 TO ENHANCE 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 2019, MOWA AND THE INSTITUTE TESTED AND SCALED THE CLIENT CHANGE OF CONDITION AND CARE COORDINATION PROTOCOL ACROSS MORE THAN 30 NEW MOW PROGRAMS NATIONWIDE. IN ADDITION TO ADOPTING THE CLIENT CHANGE OF CONDITION AND CARE COORDINATION PROTOCOL, THESE PROGRAMS EXCHANGED IDEAS WITH THEIR PEERS, SHARED PROMISING PRACTICES AND COLLECTIVELY ADDRESSED CHALLENGES FACED WHEN IMPLEMENTING THE PROTOCOL IN THEIR RESPECTIVE PROGRAMS AND COMMUNITIES. ADDRESSING UNMET SOCIAL NEEDS - UNIVERSITY OF CALIFORNIA, IRVINE IN COLLABORATION WITH THE UNIVERSITY OF CALIFORNIA, IRVINE (UCI), THE INSTITUTE COMPLETED THE FINAL YEAR OF A 3-YEAR PROJECT THAT ADVANCED PERSON-CENTERED CARE PRACTICES WITHIN AN ESTABLISHED SENIOR HEALTH CENTER. THE PROJECT EMBEDDED A CARE NAVIGATOR WITHIN THE CARE TEAM, TO SCREEN HIGH-RISK SENIOR PATIENTS FOR UNMET SOCIAL NEEDS, AND UTILIZED A TECHNOLOGY PLATFORM TO LINK PATIENTS TO NEEDED COMMUNITY-BASED PROGRAMS AND SUPPORT SERVICES. IN 2019, A PRACTICAL GUIDE TO ADDRESSING THE SOCIAL NEEDS OF OLDER ADULTS WAS PUBLISHED TO ASSIST HEALTHCARE PROVIDERS TO IMPLEMENT A SOCIAL NEEDS SCREENING AND REFERRAL PROGRAM FOR OLDER PATIENTS WITHIN CLINICAL PRACTICES. THE GUIDE INCLUDED THE FIRST OF ITS KIND SENIOR-SPECIFIC SOCIAL NEEDS SCREENING TOOL.
FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICES	MALNUTRITION SCREENING IN AN ED SETTING - UNIVERSITY OF NORTH CAROLINA EMERGENCY DEPARTMENT SENIOR MALNUTRITION IS A COMPLEX, MULTIFACETED CONDITION THAT CONTRIBUTES TO POOR HEALTH AND OVER $51 BILLION IN ANNUAL HEALTH-RELATED COSTS. IN RECOGNITION OF THE SIGNIFICANT IMPACT OF MALNUTRITION ON THE COST OF HEALTHCARE AND SUCCESSFUL AGING, THE INSTITUTE, IN COLLABORATION WITH THE UNIVERSITY OF NORTH CAROLINA HOSPITALS' GERIATRIC EMERGENCY DEPARTMENTS (GED) ADVANCED CARE FOR SENIORS BY SCREENING FOR MALNUTRITION, MALNUTRITION RISK, AND FOOD INSECURITY IN THE GED. IN 2019, A PROCESS TO SYSTEMATICALLY IDENTIFY SENIOR PATIENTS WHO WERE AT-RISK FOR MALNUTRITION AND FOOD INSECURITY WAS ESTABLISHED WITHIN THE GED, WITH IDENTIFIED PATIENTS LINKED TO COMMUNITY-BASED SOLUTIONS THAT ADDRESSED THE SOCIAL RISK FACTORS OF BOTH FOOD INSECURITY AND MALNUTRITION. FOOD INSECURITY AND MALNUTRITION SCREENING TOOLS WERE TESTED AND INCORPORATED INTO THE GED WORKFLOW AND ELECTRONIC HEALTH RECORD.
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., ("WMC") IS A NON-PROFIT, TAXABLE ENTITY THAT PROVIDES SERVICES TO AFFILIATED ORGANIZATIONS. CERTAIN SUPERVISORY, FINANCIAL AND OTHER ADMINISTRATIVE FUNCTIONS ARE PERFORMED BY EMPLOYEES OF GARY AND MARY WEST MANAGEMENT COMPANY, INC. DIANA CAMPAU (THROUGH 8/1/2019), WILLIAM EARLEY (FROM 5/24/2019), SALLY HALLAK, SIOBHAN GRAHAM ARE OFFICERS OF WHI AND RELATED ORGANIZATIONS BUT ARE DIRECT EMPLOYEES OF WMC. (REFER TO SCHEDULE J). TOTAL OFFICER COMPENSATION PAID TO THESE OFFICERS IS $967,629.
FORM 990, PART VI, SECTION A, LINE 6	THE ORGANIZATION IS A NON-PROFIT, NON-STOCK CORPORATION WITH THREE MEMBERS DURING 2019. 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 (THROUGH 12/11/2019), JAMES K HASSON (EFFECTIVE 12/12/2019) 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 2019 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 (THROUGH 5/24/2019) AND OTHER SENIOR MANAGEMENT ROLES.
FORM 990, PART IX, LINE 11G	CONSULTANTS: PROGRAM SERVICE EXPENSES 739,592. MANAGEMENT AND GENERAL EXPENSES 522,481. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,262,073. STUDIES/WHITEPAPERS/RESEARCH: PROGRAM SERVICE EXPENSES 8,335,524. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,335,524. STAKEHOLDER COMMUNICATIONS: PROGRAM SERVICE EXPENSES 127,575. MANAGEMENT AND GENERAL EXPENSES 1,347,387. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,474,962. OTHER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,024. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,024.
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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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?
(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	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 1313 N MARKET ST SUITE 5300 WILMINGTON,DE19801 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) 2019

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	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	(i) Section 512(b)(13) controlled entity?
(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	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) 2019

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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) 2019

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

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) 2019

Additional Data

Software ID:
Software Version:

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
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	3
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 2019 (Part V, line 2a) ......	5	32
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 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	25,750,000	23,000,000
9	Program service revenue (Part VIII, line 2g) .........	0	0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	87	920
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	75,000	828
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	25,825,087	23,001,748
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	47,392	19,280
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)	4,843,533	5,578,561
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	21,963,511	18,533,484
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	26,854,436	24,131,325
19	Revenue less expenses. Subtract line 18 from line 12.......	-1,029,349	-1,129,577
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	12,461,358	9,611,066
21	Total liabilities (Part X, line 26).............	6,459,282	4,738,567
22	Net assets or fund balances. Subtract line 21 from line 20.....	6,002,076	4,872,499

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 16,968,584 including grants of $ 19,280 ) (Revenue $ )
	IN 2019, THE GARY AND MARY WEST HEALTH INSTITUTE ("WHI OR "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 ORGANIZATION IS COMMITTED TO LOWERING THE COST OF HEALTHCARE AND ENABLING 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.THE INSTITUTE CONTINUED TO ADVANCE A NATIONAL RESEARCH AGENDA TO CREATE HEALTHCARE DELIVERY MODELS AND DRIVE NEW POLICIES AND PRACTICES TO IMPROVE CARE, INCREASE ACCESS AND REDUCE COSTS FOR OUR FAST-GROWING, DIVERSE POPULATION OF SENIORS. IN ADDITION TO ITS COMMITMENT TO LOWER THE COST OF HEALTHCARE, 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 (ED), 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.LOWERING THE COST OF HEALTHCARETHE RISING COST OF HEALTHCARE IS A GROWING ECONOMIC AND PUBLIC HEALTH CRISIS THAT HURTS THE U.S. ECONOMY, THREATENS INDIVIDUAL FINANCIAL SECURITY, COMPROMISES CARE AND REDUCES PATIENT ACCESS. EXCESSIVE SPENDING ON HEALTHCARE PLACES SIGNIFICANT BURDENS ON AMERICAN BUSINESSES AND FAMILY BUDGETS AND ENDANGERS THE FUNDING OF VITAL PROGRAMS SUCH AS MEDICARE AND MEDICAID. RISING COSTS FOR MEDICAL TESTS AND PROCEDURES, PHYSICIAN VISITS, AND HOSPITAL SERVICES DUE TO AN OUTDATED FEE-FOR-SERVICE PAYMENT MODEL THAT REWARDS VOLUME OVER VALUE AND MARKET FAILURES THAT ALLOW EXORBITANT PRICES FOR SERVICES AND PRODUCTS, HAVE MADE HEALTHCARE EXTREMELY EXPENSIVE LEAVING PATIENTS WITH LESS COVERAGE, MORE OUT-OF-POCKET COSTS AND RISING PREMIUMS.MOREOVER, IT IS A COMMON MISCONCEPTION THAT BECAUSE OF MEDICARE COVERAGE SENIORS (OVER 65) IN THE US ARE SHIELDED FROM THE BURDENS OF THE HIGH COST OF HEALTHCARE. OLDER ADULTS, ESPECIALLY VULNERABLE AND FRAIL SENIORS, EXPERIENCE COSTS BOTH DIRECTLY (ONLY A PORTION OF DRUGS AND SERVICES ARE COVERED) AS WELL AS INDIRECTLY VIA PERVERSE INCENTIVES ON HEALTHCARE SYSTEMS THAT DEMAND PROFIT OVER PATIENT OUTCOMES. ULTIMATELY, IT IS ESSENTIAL TO LOWER THE COST OF HEALTHCARE IN THE US IF SENIORS ARE TO SUCCESSFULLY AGE IN AMERICA. GIVEN THE SERIOUS AND URGENT NATURE OF THIS ISSUE, WHI HAS ADDRESSED THE COST OF HEALTH CARE VIA SEVERAL AVENUES. THE INSTITUTE HAS DIRECTLY SUPPORTED WORKSTREAMS FOCUSED ON LOWERING THE COST OF CARE - WHEN APPROPRIATE IN COLLABORATION WITH THE WEST HEALTH POLICY CENTER (WHPC) - AND HAS ALSO PUT SIGNIFICANT EFFORT INTO ENSURING THAT THE MAJORITY OF THE RESEARCH UNDERTAKEN UNDER THE BANNER OF SUCCESSFUL AGING ALSO SPEAKS TO DRIVING VALUE AND COST REDUCTION FOR CARE EXPERIENCED BY SENIORS. OVER THE COURSE OF 2019, WHI ORGANIZED ITS WORK INTO SEVERAL AREAS OF CONCENTRATION, WHICH INCLUDE WORK DESIGNED TO HIGHLIGHT AND BRING ATTENTION TO THE SERIOUSNESS AND URGENCY OF THIS CRISIS AS WELL AS PROPOSE BOLD SOLUTIONS TO MOVE FORWARD. SPECIFICALLY, THREE COMMON SENSE REFORMS - ALLOWING MEDICARE TO DIRECTLY NEGOTIATE PRESCRIPTION DRUG PRICES WITH DRUG COMPANIES, ACCELERATING THE MOVE TO A VALUE-BASED CARE SYSTEM AND INCREASING TRANSPARENCY ABOUT THE VALUE OF SERVICES - WERE ADVANCED AS KEY TO LOWERING HEALTHCARE COSTS, IMPROVING HEALTH OUTCOMES, AND ENABLING THE CREATION OF A SYSTEM THAT IS MORE TRANSPARENT, COMPETITIVE, AFFORDABLE, PERSON-CENTERED, QUALITY-DRIVEN AND SUSTAINABLE.RAISE AWARENESS OF SPENDING CRISIS AND URGENCYTO FOCUS THE ATTENTION OF POLICYMAKERS, ADMINISTRATORS, THE BUSINESS COMMUNITY, AND THE GENERAL PUBLIC ON THE HEALTHCARE CRISIS, WHI LED AND SUPPORTED SEVERAL KEY EFFORTS IN 2019. BUILDING ON EARLIER SUCCESSES WITH PUBLIC SURVEY WORK DONE WITH THE NATIONAL OPINION RESEARCH CENTER AT THE UNIVERSITY OF CHICAGO, THE INSTITUTE IS RESEARCHING THE AMERICAN PUBLIC'S PERCEPTIONS OF HEALTHCARE AND PRESCRIPTION DRUG COSTS THROUGH A THREE-YEAR ENGAGEMENT WITH GALLUP THAT STARTED AT THE END OF 2018 TO DEVELOP A RECURRING NATIONAL SURVEY OF KEY ISSUES REGARDING HEALTHCARE COSTS. IN ADDITION TO DEMOGRAPHIC AND DESCRIPTIVE DATA, AREAS OF FOCUS INCLUDE: * PUBLIC PERCEPTION OF THE US HEALTHCARE SYSTEM FROM COST AND QUALITY PERSPECTIVES * MEDICAL CARE FORGONE DUE TO COSTS * UNDERSTANDING AND TRANSPARENCY OF PRICES FOR DRUGS AND HEALTH PROCEDURES * FINANCIAL BURDEN ON HOUSEHOLDS DUE TO HEALTHCARE COSTS * ENGAGEMENT WITH THE POLITICAL PROCESS AROUND HEALTHCARE COST ISSUESIN 2019, TWO NATIONAL SURVEYS WERE PUBLISHED WITH FULL REPORTS AND SUPPORTING MATERIALS FOR PUBLIC CONSUMPTION TO DRIVE VISIBILITY AND AWARENESS OF THESE ISSUES AND HOW COSTS ARE IMPACTING THE LIVES OF AMERICANS EVERY DAY. THE FIRST GALLUP/WHI SURVEY ON HEALTHCARE COSTS WITH A SAMPLE SIZE OF 3,500 RESPONDENTS WAS UNVEILED AT THE HEALTHCARE INNOVATION SUMMIT (HCI) IN WASHINGTON D.C. IN APRIL AND ACHIEVED A SUBSTANTIAL MEDIA IMPACT, WITH COVERAGE OF THE SURVEY IN MAJOR NATIONAL MEDIA.THE SECOND SURVEY ON HEALTHCARE COSTS, USING A SMALLER SCALE SAMPLE SIZE OF APPROXIMATELY 1,000 RESPONDENTS, WAS RELEASED IN NOVEMBER OF 2019 TO IMPRESSIVE MEDIA COVERAGE, INCLUDING THREE SEPARATE SYNDICATED STORIES IN THE ASSOCIATED PRESS AND SUBSTANTIAL SOCIAL MEDIA DISTRIBUTION AND CITATIONS OF THIS DATA BY ELECTED OFFICIALS AND PRESIDENTIAL CANDIDATES, IN PARTICULAR FOR THE POLL'S STRIKING RESULTS HIGHLIGHTING THE SHARE OF ADULTS WHO REPORTED KNOWING SOMEONE WHO DIED DUE TO THE UNAFFORDABILITY OF CARE.WHI ALSO ACTIVELY CONTRIBUTED TO THE SUCCESS OF THE WELL-ATTENDED 2019 HCI SUMMIT IN WASHINGTON D.C. THE SUMMIT, WHICH FEATURED FORMER GOVERNORS AND ADMINISTRATION HEADS, RESPECTED HEALTHCARE REPORTERS, AND BUSINESS AND HEALTHCARE LEADERS, HAD OVER 1,000 IN-PERSON ATTENDEES AND GARNERED THOUSANDS MORE ONLINE.DEVELOP ACTIONABLE POLICIES TO LOWER DRUG COSTSTRATEGIES TO REDUCE THE RISING COST OF PHARMACEUTICALS HAVE BEEN A KEY COMPONENT OF THE COST OF HEALTHCARE WORK. IN DECEMBER OF 2019, THE HOUSE OF REPRESENTATIVES PASSED LEGISLATION (HR3) THAT WOULD ALLOW MEDICARE TO NEGOTIATE DRUG PRICES. SINCE WHI HAS DEMONSTRATED THROUGH ITS RESEARCH THE POTENTIAL BENEFITS OF DIRECT NEGOTIATION OF DRUG PRICES, IT WAS GRATIFIED TO SEE THE ENACTMENT OF HR3. IN SUPPORT OF BROAD POLICY CHANGES IN THE AREAS OF DRUG PRICING AND SIMILAR AREAS OF HEALTHCARE COST CONCERN, WHI PROVIDED DATA SCIENCE EXPERTISE TO PROJECTS (LED BY WHPC) MODELING THE HEALTH COSTS OF CURRENT DRUG PRICES AS WELL AS ESTIMATES OF THE SAVINGS ASSOCIATED WITH CHANGES IN THE MEDICARE PARTS B AND D PROGRAMS.ADDITIONALLY, WHI COLLABORATED IN DEVELOPING THE EVIDENCE FOR LOWERING PRESCRIPTION DRUG PRICES AND ENSURING THAT THIS EVIDENCE WAS PRESENTED TO APPROPRIATE STAKEHOLDERS IN THE LEGISLATIVE, POLICY, AND MEDIA MILIEU. DEVELOP ACTIONABLE POLICIES TO REDUCE VOLUME INCENTIVES IN FEE-FOR-SERVICEVALUE-BASED CARE (VBC) WHICH INCORPORATES RISK FOR BOTH HEALTH AND SPENDING OUTCOMES INTO PAYMENT RATES HAS THE POTENTIAL TO REDUCE MANY OF THE VOLUME-BASED FINANCIAL INCENTIVES THAT ARE DRIVING UP PER-CAPITA HEALTHCARE COSTS. IN 2019, WHI SUPPORTED AN IMPORTANT COLLABORATION IN WHICH WHPC AND THE DUKE-MARGOLIS CENTER FOR HEALTH POLICY ORGANIZED AND PARTICIPATED IN EXPERT ROUNDTABLES ON STATE AND NATIONAL MODELS OF VBC. THESE THOUGHT-PROVOKING ROUNDTABLES PLAYED A KEY ROLE IN DEVELOPING LANDSCAPE ASSESSMENTS OF SUCCESSFUL MODELS OF VALUE-BASED PAYMENT REFORMS TO SUPPORT THE SPREAD OF VBC AT THE STATE AND NATIONAL LEVELS. TOGETHER WITH A FOCUSED, EXPERT-GUIDED REVIEW OF THE LATEST PAYMENT REFORM EVIDENCE, THE INSTITUTE AND DUKE-MARGOLIS ARE DEVELOPING A ROADMAP FOR IMPROVING CARE VALUE AND REDUCING COSTS THROUGH PAYMENT REFORM. THE ROADMAP IS CURRENTLY IN PUBLICATION/PRODUCTION AND FEATURES ACTIONABLE, PROMISING STEPS TO ADVANCE PAYMENT REFORM, AND TO ENABLE HEALTH CARE ORGANIZATIONS TO SUCCEED IN LOWERING COSTS. IN ADDITION TO THE ABOVE, THE DUKE-MARGOLIS CENTER WAS TASKED TO BUILD ON THEIR PAST WORK INVOLVING A RANGE OF STATES INCLUDING COLLABORATIONS WITH STATE POLICYMAKERS AND RESEARCHERS, CMS, AND HEALTH CARE TRANSFORMATION LEADERS TO DEVELOP A SET OF RESOURCES TO ACCELERATE EFFECTIVE STATE-BASED REFORMS.

4b	(Code: ) (Expenses $ 438,301 including grants of $ ) (Revenue $ )
	THE RISING COST OF HEALTHCARE IS A GROWING ECONOMIC AND PUBLIC HEALTH CRISIS THAT HURTS THE U.S. ECONOMY, THREATENS INDIVIDUAL FINANCIAL SECURITY, COMPROMISES CARE AND REDUCES PATIENT ACCESS. EXCESSIVE SPENDING ON HEALTHCARE PLACES SIGNIFICANT BURDENS ON AMERICAN BUSINESSES AND FAMILY BUDGETS AND ENDANGERS THE FUNDING OF VITAL PROGRAMS SUCH AS MEDICARE AND MEDICAID. RISING COSTS FOR MEDICAL TESTS AND PROCEDURES, PHYSICIAN VISITS, AND HOSPITAL SERVICES DUE TO AN OUTDATED FEE-FOR-SERVICE PAYMENT MODEL HAVE MADE HEALTHCARE EXTREMELY EXPENSIVE LEAVING PATIENTS WITH LESS COVERAGE, MORE OUT-OF-POCKET COSTS AND RISING PREMIUMS.TO TACKLE THIS CRITICAL ISSUE, THE WEST HEALTH INSTITUTE CONTINUES TO LEAD EFFORTS TO RAISE AWARENESS OF SPENDING CRISIS AND URGENCY, DEVELOP ACTIONABLE POLICIES TO LOWER DRUG COST AND REDUCE VOLUME INCENTIVES IN FEE-FOR-SERVICE AND DRIVE TRANSPARENCY IN THE HEALTH CARE SYSTEM.TO SUPPLEMENT AND BROADEN THE INSTITUTE'S MEDICAL RESEARCH ACTIVITIES, THE INSTITUTE ALSO PARTICIPATED IN PUBLIC EDUCATION, POLICY WORK AND THE DISSEMINATION OF RESEARCH FINDINGS TO THOSE INTERESTED IN REDUCING THE COST OF HEALTHCARE SERVICES AND DEVELOPING SENIOR-APPROPRIATE ACUTE, CHRONIC CARE AND SUPPORTIVE SERVICE 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 expenses17,406,885

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,928,328	1,949,872	436,978

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(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
(A) Name and title
(18) JOSEPH M SMITH........................................................................ FORMER CO-MANAGER/CMO(THRU 3/31/16)	0.00 .......................50.00	X	0	805,361	57,634

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	23,000,000
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		23,000,000

		Business Code
2a
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....

3 Investment income (including dividends, interest, and othersimilar amounts) ......			20			20
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........			828	828
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	900		7a
b	Less: cost or other basis and sales expenses	0		7b
c	Gain or (loss)	900		7c
d	Net gain or (loss).........			900			900
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			23,001,748	828	0	920

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	19,280	19,280
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, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,701,360	1,297,994	403,366
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........	3,069,652	2,835,642	234,010
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	139,075	139,088	-13
9	Other employee benefits .......	391,284	366,880	24,404
10	Payroll taxes ...........	277,190	237,353	39,837
11	Fees for services (non-employees):
a	Management ......	2,871,997	733,439	2,138,558
b	Legal .........	109,561	35,823	73,738
c	Accounting ...........	75,892		75,892
d	Lobbying ...........	402,000	402,000
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)	11,073,583	9,202,691	1,870,892
12	Advertising and promotion ....
13	Office expenses .......	36,456	8,016	28,440
14	Information technology ......	509,367	115,529	393,838
15	Royalties ..
16	Occupancy ...........	1,787,805	1,028,936	758,869
17	Travel ............	514,253	355,726	158,527
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	80,438	66,649	13,789
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	551,721	307,290	244,431
23	Insurance ...	89,167	30,237	58,930
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	172,515	112,369	60,146
b	SUBSCRIPTIONS & PUBLICA	124,082	66,884	57,198
c	RECRUITING & RETENTION	69,721	15,997	53,724
d	EQUIPMENT & SUPPLIES	33,224	15,341	17,883
e	All other expenses	31,702	13,721	17,981
25	Total functional expenses. Add lines 1 through 24e	24,131,325	17,406,885	6,724,440	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			4,114,998	1	7,157,996
2	Savings and temporary cash investments .........			759,012	2	9,787
3	Pledges and grants receivable, net ......			5,000,000	3	0
4	Accounts receivable, net .............			150,319	4	540,820
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			900,646	9	840,065
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	10,486,952
b	Less: accumulated depreciation	10b	9,522,533	1,379,658	10c	964,419
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			156,725	14	97,979
15	Other assets. See Part IV, line 11 ...........				15
16	Total assets. Add lines 1 through 15 (must equal line 33)...			12,461,358	16	9,611,066

17	Accounts payable and accrued expenses .....	5,430,037	17	4,035,452
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 any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			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	1,029,245	25	703,115
26	Total liabilities. Add lines 17 through 25..	6,459,282	26	4,738,567

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	6,002,076	27	1,536,103
28	Net assets with donor restrictions ...........		28	3,336,396
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	6,002,076	32	4,872,499
33	Total liabilities and net assets/fund balances ........	12,461,358	33	9,611,066