TY 2023 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
GARY AND MARY WEST MANAGEMENT COMPA, 4960 AVENIDA ENCINAS CARLSBAD,CA92008	MANAGEMENT SERVICES	2,194,865
GALLUP INC, PO BOX 74007531 CHICAGO,IL60674	CONSULTANT	700,099
99 TEN BUSINESS SOLUTIONS, 7040 AVENIDA ENCINAS SUITE 104-242 CARLSBAD,CA92011	IT CONSULTANT	377,489
GEORGETOWN UNIVERSITY, 37TH AND O STREETS NW WASHINGTON,DC20057	CONSULTANT	263,000
CURA STRATEGIES LLC, 2011 CRYSTAL DR SUITE 1005 ARLINGTON,VA22202	CONSULTANT	240,163
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 20

- TIN:

SCHEDULE A
(Form 990)

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.
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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

2023

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).)

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:

ADVOCATE AURORA HEALTH

MILWAUKEE

DARTMOUTH-HITCHCOCK CLINIC

LEBANON

DIMER HEALTH SERVICES INC

MENDHAM

GARY AND MARY WEST SENIOR SERVICES INC

SAN MARCOS

GEISINGER HEALTH

DANVILLE

HARDISON MEDICAL CORPORATION DBA HEALTHTOPIA

ENCINITAS

INTEGRA COMMUNITY CARE NETWORK

WARWICK

PATIENT & FAMILY CENTERED CARE PARTNERS

LONG BEACH

PRIME HEALTHCARE FOUNDATION INC

ONTARIO

ST JOSEPH'S HEALTH PARTNERS

PATERSON

THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

CHAPEL HILL

UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE

CHARLOTTESVILLE

YALE SCHOOL OF MEDICINE

NEW HAVEN

UNIVERSITY OF CALIFORNIA SAN DIEGO

LA JOLLA

CLEVELAND CLINIC

CLEVELAND

SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

PASADENA

KENT COUNTY MEMORIAL HOSPITAL

WARWICK

SHARP HEALTHCARE

SAN DIEGO

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 33 1/3% 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 33 1/3% 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 on 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 5 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 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. 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—2022. 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—2023. 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—2022. 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 on 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 5 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 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. 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—2022. 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) 2023

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

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 on 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 on 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) 2023

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2023

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 0.015 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 0.035	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) 2023

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2023 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

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) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2023

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) (2023)

Schedule B (Form 990) (2023) 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) (2023)

Schedule B (Form 990) (2023)

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) (2023)

Schedule B (Form 990) (2023)

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) (2023)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

right arrow

Complete if the organization is described below. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

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

OMB No. 1545-0047

2022

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 .................................................................... right arrow

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 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

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 ..... right arrow

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

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

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.

Cat. No. 50084S

Schedule C (Form 990) 2022

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 right arrow

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 right arrow

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) ........................	216,000
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................	216,000
d	Other exempt purpose expenditures ...............................................................................	20,912,925
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................	21,128,925
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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) Total

2a	Lobbying nontaxable amount	1,000,000	1,000,000	1,000,000	1,000,000	4,000,000

b	Lobbying ceiling amount (150% of line 2a, column(e))					6,000,000

c	Total lobbying expenditures	291,000	217,590	216,480	216,000	941,070

d	Grassroots nontaxable amount	250,000	250,000	250,000	250,000	1,000,000

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,500,000

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2022

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) 2022

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.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

2022

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

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

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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

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 right arrow

Permanent endowment right arrow

Term endowment right arrow

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	7,091,700	6,844,389	247,311
d	Equipment ....	2,231,337	2,170,201	61,136
e	Other .....	1,709,053	1,390,060	318,993
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				627,440

Schedule D (Form 990) 2022

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)OPERATING LEASE RIGHT-OF-USE ASSET				8,252,565
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				8,252,565

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
FINANCE LEASES	33,216
OPERATING LEASE LIABILITY	8,974,391







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	9,007,607
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) 2022

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	21,241,141
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
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ...........	2d
e	Add lines 2a through 2d .....................		2e	0
3	Subtract line 2e from line 1..................		3	21,241,141
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	21,241,141

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	21,128,925
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ...........	2d
e	Add lines 2a through 2d....................		2e	0
3	Subtract line 2e from line 1...................		3	21,128,925
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	21,128,925

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, 2023. THERE HAVE BEEN NO RELATED TAX PENALTIES OR INTEREST, WHICH WOULD BE CLASSIFIED AS TAX EXPENSE IN THE STATEMENT OF ACTIVITIES.

SCHEDULE D, PART IX LINE 1 AND PART X LINE 2

THE INSTITUTE LEASES ITS LA JOLLA FACILITY UNDER A NON-CANCELABLE OPERATING LEASE AGREEMENT THAT WILL EXPIRE IN APRIL 2028. WHI ADOPTED THE NEW LEASE STANDARD ASC 842 AT THE BEGINNING OF 2021. IN ACCORDANCE WITH ASC 842, THE INSTITUTE RECOGNIZES A RIGHT-OF-USE ASSET AND LEASE LIABILITY IN THE BALANCE SHEET RELATED TO THE OPERATING LEASE. DURING 2023, THE INSTITUTE RECEIVED A TENANT REIMBURSEMENT IN THE AMOUNT OF $73,055.

Schedule D (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
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Attach to Form 990.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

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

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) 2023

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1SHELLEY M LYFORD DIRECTOR, CHAIR & CEO	(i) (ii)	626,083 ------------- 0	180,263 ------------- 0	23,040 ------------- 0	11,250 ------------- 0	9,106 ------------- 0	849,742 ------------- 0	0 ------------- 0
2ZIA AGHA CMO & EVP CLINICAL RESEARCH	(i) (ii)	602,437 ------------- 0	146,007 ------------- 0	24,048 ------------- 0	16,500 ------------- 0	60,414 ------------- 0	849,406 ------------- 0	0 ------------- 0
3TIMOTHY LASH PRESIDENT	(i) (ii)	538,220 ------------- 0	160,047 ------------- 0	23,040 ------------- 0	9,700 ------------- 0	48,519 ------------- 0	779,526 ------------- 0	0 ------------- 0
4JONATHAN ZIFFERBLATT CHIEF STRATEGY OFFICER	(i) (ii)	0 ------------- 417,288	0 ------------- 125,000	0 ------------- 23,362	0 ------------- 16,500	0 ------------- 43,487	0 ------------- 625,637	0 ------------- 0
5SALLY HALLAK CFO, SECRETARY AND TREASURER	(i) (ii)	0 ------------- 360,105	0 ------------- 120,975	0 ------------- 23,063	0 ------------- 16,500	0 ------------- 17,830	0 ------------- 538,473	0 ------------- 0
6LIANE WARDLOW SENIOR DIRECTOR, CLINICAL RESEARCH	(i) (ii)	215,516 ------------- 0	29,700 ------------- 0	469 ------------- 0	7,400 ------------- 0	32,789 ------------- 0	285,874 ------------- 0	0 ------------- 0
7AMY STUCK SENIOR DIRECTOR, VALUE-BASED ACUTE	(i) (ii)	193,976 ------------- 0	28,337 ------------- 0	1,196 ------------- 0	11,465 ------------- 0	43,700 ------------- 0	278,674 ------------- 0	0 ------------- 0
8CHRISTOPHER CROWLEY PROGRAM MANAGER	(i) (ii)	219,326 ------------- 0	19,275 ------------- 0	1,362 ------------- 0	12,047 ------------- 0	22,918 ------------- 0	274,928 ------------- 0	0 ------------- 0
9ADRIAN KWONG PRINCIPAL DATA SECURITY ARCHITECT	(i) (ii)	204,442 ------------- 0	16,823 ------------- 0	436 ------------- 0	10,391 ------------- 0	22,241 ------------- 0	254,333 ------------- 0	0 ------------- 0
10HAW-MINN LU PRINCIPAL DATA SCIENTIST	(i) (ii)	190,146 ------------- 0	14,110 ------------- 0	764 ------------- 0	10,583 ------------- 0	38,272 ------------- 0	253,875 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2023

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 4B	17B: EACH OF THE FOLLOWING INDIVIDUALS TIMOTHY 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 2023 THIS AMOUNT WAS $22,500. CONTRIBUTIONS WERE MADE FOR TIMOTHY LASH, ZIA AGHA AND SHELLEY LYFORD. JONATHAN ZIFFERBLATT AND SALLY HALLAK (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. FOR 2023 THIS AMOUNT WAS $22,500. CONTRIBUTIONS WERE MADE FOR JONATHAN ZIFFERBLATT AND SALLY HALLAK.
PART I, LINE 7	EACH OF THE MANAGERS IS ELIGIBLE FOR AN ANNUAL DISCRETIONARY BONUS, SUBJECT TO COMPENSATION COMMITTEE REVIEW AND APPROVAL. THIS IS BASED ON INDIVIDUAL PERFORMANCE AND LIMITED TO A MAXIMUM PERCENTAGE OF BASE COMPENSATION.

Schedule J (Form 990) 2023

Additional Data

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- TIN:

Schedule L
(Form 990)

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.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

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. ........................... $

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ $

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) 2023

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

SCHEDULE L, PART IV

BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: GARY WEST, A DIRECTOR OF THE WEST HEALTH INSTITUTE, IS A MEMBER OF 99 TEN BUSINESS SOLUTIONS, 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 INSTITUTE AND 99 TEN BUSINESS SOLUTIONS, LLC DURING 2023. TOTAL TRANSACTION AMOUNT IS $377,489 FOR IT CONSULTING SERVICES. THE AMOUNT PAID WAS LESS THAN THE COMMERCIAL MARKET CHARGES FOR SUCH SERVICES.

Schedule L (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

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:	OVER THE COURSE OF 2023, THE GARY AND MARY WEST INSTITUTE (REFERRED TO BELOW VARIOUSLY AS WHI, WEST HEALTH INSTITUTE, OR INSTITUTE) CONTINUED TO ACTIVELY CONDUCT APPLIED MEDICAL RESEARCH, IN CONJUNCTION WITH THE HOSPITALS LISTED ON SCHEDULE A, WITH THE OBJECTIVE OF CONTRIBUTING TO THE BODY OF CLINICAL, SCIENTIFIC, AND HEALTH KNOWLEDGE THAT CAN ULTIMATELY BENEFIT OLDER ADULTS IN AMERICA. OUR RESEARCH METHODOLOGIES ENCOMPASS A VARIETY OF REAL-WORLD DATA COLLECTION AND ANALYSIS TECHNIQUES, AND IN MANY CASES, WE IMPLEMENT PROGRAMS AND STRUCTURES (E.G., STANDARDIZED CARE MODELS, DATA DASHBOARDS, ETC.) THAT ALLOW US TO COLLECT SYSTEMATIZED RESEARCH INFORMATION WHERE LITTLE PREVIOUSLY EXISTED. THESE MEDICAL RESEARCH EFFORTS DIRECTLY SUPPORTED WHI'S MISSION OF 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. OUR MAJOR WORKSTREAMS FOR 2023 BROADLY FIT INTO THE AREAS OF (SENIOR APPROPRIATE) ACUTE CARE RESEARCH, CHRONIC CARE RESEARCH, AND TELEHEALTH RESEARCH AND ARE DESCRIBED BELOW. SENIOR-APPROPRIATE ACUTE CARE RESEARCH IN 2023, THE INSTITUTE CONTINUED TO EXPAND ITS RESEARCH PORTFOLIO AND GROW THE BODY OF EVIDENCE FOR NEW STRATEGIES IN ACUTE CARE. UNPLANNED (ACUTE) NEEDS REMAIN THE PRIMARY DRIVER OF COSTS FOR THE NATION'S VULNERABLE OLDER ADULTS, AS WELL AS LEADING TO LASTING DETRIMENTAL EFFECTS (E.G., POST-VISIT DEBILITATION AND FUNCTIONAL DECLINE). SUCCESS IN THIS AREA IS ESSENTIAL TO ACHIEVING BETTER, MORE AFFORDABLE OUTCOMES FOR OLDER ADULTS. ACUTE CARE RESEARCH AREA: GERIATRIC EMERGENCY DEPARTMENTS (GEDS) MEET THE DEMANDS OF A GROWING GED MOVEMENT, EVALUATE THE CLINICAL IMPACT, AND DEVELOP A SUSTAINABILITY PLAN TO ENSURE LONG TERM SUCCESS OF THE GEDA PROGRAM. OUR PARTNERSHIP WITH THE AMERICAN ACADEMY OF EMERGENCY PHYSICIANS (ACEP) WAS FOCUSED IN 2023 ON IMPROVING THEIR APPLICATION PROCESS BY ENABLING TECHNOLOGY IMPROVEMENTS AND CREATING APPLICATION THROUGHPUT EFFICIENCY. A NEW TECHNOLOGY PLATFORM WAS INITIATED TO PROCESS THE INCREASING APPLICATION DEMANDS, AND STAFF WERE BROUGHT ON TO MEET THE NEEDS OF IMPROVING APPLICATION THROUGHPUT. AS A RESULT, APPLICATION THROUGHPUT TIME IMPROVED, ALLOWING MORE 65+ PATIENTS TO HAVE ACCESS TO A GED AT A LOCAL HOSPITAL NEAR THEM THIS YEAR. (AT THE CLOSE OF 2023, GEDS COULD BE FOUND IN WELL OVER 400 HOSPITALS ACROSS THE US.) THIS YEAR WHI ALSO FOCUSED ON DEMONSTRATING CLINICAL IMPACT, FINANCIAL ROI, AND DRIVE QUALITY IMPROVEMENT. ONE WAY THAT WEST HEALTH AND ACEP HAVE PARTNERED TO ACHIEVE THIS IS THROUGH THE GED DASHBOARD, A MECHANISM MADE DIRECTLY AVAILABLE TO HOSPITALS AND HEALTH SYSTEMS FOR INDIVIDUAL ED SITES TO TRACK QUALITY IMPROVEMENT THROUGH AGGREGATE LEVEL DATA. BUILDING CASE FOR SUSTAINABILITY GERIATRIC EMERGENCY CARE IN PARTNERSHIP WITH CLEVELAND CLINIC: IN 2023, WEST HEALTH PARTNERED WITH CLEVELAND CLINIC (CC) TO STUDY THE PROCESS AND PROTOCOLS OF THE VARIOUS CLEVELAND CLINIC GED SITES TO BETTER UNDERSTAND HIGH-RISK GERIATRIC PATIENT OUTCOMES AND UNDERSTAND THE RETURN ON INVESTMENT. THIS CASE STUDY, SHARED VIA WEBINAR, FOUND A REDUCTION IN MEDICALLY UNNECESSARY ADMISSIONS WHICH FREED UP HIGH DEMAND IN-PATIENT BEDS AND RESULTED IN COST SAVINGS FOR THE (CC) HOSPITAL SYSTEM. WEST HEALTH AND CLEVELAND CLINIC JOINTLY CREATED A 2-PAGE SUSTAINABILITY CASE STUDY PROVIDING AN IMPORTANT PERSPECTIVE INTO THE BENEFITS BOTH CLINICALLY AND AS A RETURN ON INVESTMENT INTO THE VALUE OF PURSUING GED ACCREDITATION. IN ADDITION TO THE ABOVE, WEST HEALTH AND CLEVELAND CLINIC RESEARCH TEAMS FURTHER COLLABORATED IN DESIGNING A POST-IMPLEMENTATION EVALUATION OF CLEVELAND CLINIC'S NEW ELECTRONIC HEALTH RECORD-SUPPORTED DELIRIUM SCREENING PROCESS. IN PARTNERSHIP WITH THE STATEWIDE UC HEALTH SYSTEM: THE UNIVERSITY OF CALIFORNIA SAN DIEGO (UCSD) HOSPITAL HEALTH COLLABORATION SUCCESSFULLY PAVED THE WAY FOR ALL UC HEALTH SYSTEMS IN CALIFORNIA TO ACHIEVE LEVEL 1 GED ACCREDITATION WITH WHI SUPPORT. THIS YEAR, THE INSTITUTE COLLABORATED WITH UCSD TO CONDUCT AN OPERATIONAL STUDY TO DESCRIBE GED IMPLEMENTATION ACROSS THE 5 UC HEALTH GEDS, PROVIDING SUPPORT FOR DATA COLLECTION, ANALYSIS, INTERPRETATION OF RESULTS, AND DISSEMINATION. THE STUDY ASSESSED DRIVERS OF VARIATION, LESSONS LEARNED, AND IMPLEMENTATION FACILITATORS AND BARRIERS. A WORKSHOP WAS HELD WITH ALL UC SITES TO REVIEW, SYNTHESIZE, AND PLAN FOR DISSEMINATION OF THE STUDY'S RESULTS TO A VARIETY OF STAKEHOLDERS, INCLUDING PHYSICIANS, NURSES, AND RESEARCHERS. GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION ENGAGEMENT WITH COMMUNITY HOSPITALS THROUGHOUT CALIFORNIA UC SAN DIEGO HEALTH PARTNERSHIP: THE GARY AND MARY WEST SENIOR CARE NETWORK (SECN) IS A STATEWIDE EFFORT TO ENSURE THAT CALIFORNIA BECOMES A LEADER IN EMERGENCY CARE FOR OLDER ADULTS. IN A CONCERTED EFFORT TO GROW THE SECN IN 2023, THE WEST HEALTH INSTITUTE AND UC SAN DIEGO HEALTH DEVELOPED A TRAINING PROGRAM TO TEACH AND ENCOURAGE ADOPTION OF THE GED MODEL ACROSS CALIFORNIA. THIS COLLABORATION STREAMLINED ENGAGEMENT, EDUCATION, AND SUPPORT FOR HOSPITALS AS THEY IMPLEMENTED THE GED MODEL. OUTREACH WAS CONDUCTED WITH OVER 600 INDIVIDUALS THROUGHOUT THE STATE, WITH 130+ INDIVIDUALS ATTENDING TRAININGS, REPRESENTING 52 HOSPITALS ACROSS THE STATE. IN ADDITION, WHI AND THE TEAM AT UC SAN DIEGO HEALTH PROVIDED INDIVIDUALIZED SUPPORT TO HOSPITALS PURSUING GED ACCREDITATION. AS A DIRECT RESULT OF THESE EFFORTS AND MORE, NUMBER OF ACCREDITED GEDS IN CALIFORNIA INCREASED FROM 57 AT THE BEGINNING OF 2023 TO 82 ACCREDITED GEDS AS OF NOVEMBER 2023, IMPROVING PATIENT ACCESS TO OLDER ADULT APPROPRIATE EMERGENCY CARE THROUGHOUT THE STATE. HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA PARTNERSHIP: IN ADDITION TO THE PARTNERSHIP WITH UC SAN DIEGO HEALTH (ABOVE), WHI ALSO PARTNERED WITH THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) TO DRIVE SPREAD AND ADOPTION OF THE GED MODEL. THROUGHOUT 2023, OVER 460 INDIVIDUALS AFFILIATED WITH HASC MEMBER HOSPITALS WERE INTRODUCED TO THE GED MODEL THROUGH THIS COLLABORATION. WHI PARTNERED WITH HASC TO PRESENT THE SECN INITIATIVE AT THE HASC ANNUAL MEETING EXECUTIVE FORUM IN MAY 2023, EMPHASIZING THE CASE FOR IMPROVING GERIATRIC EMERGENCY CARE. 75 INDIVIDUALS ATTENDED VIRTUAL "ADVANCING GERIATRIC EMERGENCY CARE: BEST PRACTICES AND ACCREDITATION STRATEGIES" TRAINING CO-HOSTED BY WHI AND UC SAN DIEGO HEALTH, REPRESENTING 38 HOSPITALS ACROSS SOUTHERN CALIFORNIA. PRIOR TO THIS INITIATIVE, 27 HASC MEMBER HOSPITALS HAD ACHIEVED GED ACCREDITATION. AS A RESULT OF THIS COLLABORATION EIGHT (8) MORE HASC MEMBER HOSPITALS HAVE APPLIED FOR OR ACHIEVED GED ACCREDITATION IN 2023, WITH ADDITIONAL HOSPITALS CONTINUING TO PURSUE GED ACCREDITATION INTO 2024. KAISER PERMANENTE SOUTHERN CALIFORNIA PARTNERSHIP: SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP (SCPMG) IS A LEADING DRIVER IN CLINICAL CARE FOR OVER 4 MILLION MEMBERS, AND WITH AN AGING POPULATION SCPMG RECOGNIZED THE NEED TO PROVIDE GERIATRIC SPECIFIC EMERGENCY CARE TO ITS REGIONAL MEMBERS. IN PARTNERSHIP WITH AND SUPPORTED BY WEST HEALTH, 60+ INDIVIDUALS AFFILIATED WITH 17 SCPMG MEMBER HOSPITALS WERE EDUCATED ABOUT THE GED MODEL. WHI PARTNERED WITH SCPMG TO PRESENT THE GED ACCREDITATION INITIATIVE TO HEALTH SYSTEM ASSISTANT MEDICAL GROUP ADMINISTRATORS AND ASSISTANT AREA MEDICAL DIRECTORS IN OCTOBER 2023. THIRTY-NINE (39) INDIVIDUALS ATTENDED VIRTUAL "ADVANCING GERIATRIC EMERGENCY CARE: BEST PRACTICES AND ACCREDITATION STRATEGIES" TRAININGS CO-HOSTED BY WHI AND UCSD, REPRESENTING 15 HOSPITALS ACROSS SOUTHERN CALIFORNIA. PRIOR TO THIS INITIATIVE, FOUR (4) SCPMG HOSPITALS HAD ACHIEVED GED ACCREDITATION. AS A RESULT OF THIS COLLABORATION FOUR (4) MORE SCPMG HOSPITALS APPLIED FOR GED ACCREDITATION IN 2023, WITH AN ADDITIONAL NINE (9) HOSPITALS CONTINUING TO PURSUE GED ACCREDITATION INTO 2024. EXTENDING GEDS IN RURAL CRITICAL ACCESS HOSPITALS IN 2023, THE INSTITUTE CONCLUDED ITS MULTI-YEAR COLLABORATION WITH DARTMOUTH HITCHCOCK MEDICAL CENTER WHICH INCLUDED SUPPORTING TWO RURAL CRITICAL ACCESS HOSPITALS IN NEW ENGLAND TO ACHIEVE LEVEL 2 GED ACCREDITATION USING RESEARCH AND LEARNINGS FROM WORK WITH DARTMOUTH HITCHCOCK IN 2022 IN TO SUPPORT GEDS WITHIN THEIR SYSTEM. THE GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC): BUILDING MEDICAL RESEARCH EXCELLENCE IN THE GED COMMUNITY IN PARTNERSHIP WITH YALE HEALTH: IN 2023, OUR WORK WITH THE GEDC AT YALE FOCUSED ON EXPLORING THE USE OF SECONDARY DATASETS TO EVALUATE GEDS AND RESULTED IN SEVERAL CONFERENCE PRESENTATIONS AND A MANUSCRIPT IN ANNALS OF EMERGENCY MEDICINE. WHI ADDITIONALLY SUPPORTED YALE IN ESTABLISHING A DATA PLATFORM AND LEVERAGING THIS TO PERFORM PILOT STUDIES THAT WERE JOINTLY FUNDED BY THE NATIONAL INSTITUTES OF HEALTH.
FORM 990, PART III, LINE 4A, (CONTINUATION):	THESE PILOT STUDIES ENABLED JUNIOR RESEARCHERS TO STUDY PRIORITY TOPICS IN GERIATRIC EMERGENCY CARE AND RESULTED IN THREE MANUSCRIPTS THAT WERE SUBMITTED FOR PUBLICATION IN PEER-REVIEWED JOURNALS. IN PARTNERSHIP WITH UNIVERSITY OF NORTH CAROLINE HEALTH (UNC HEALTH): AT UNC HEALTH, THE WHI-GEDC COLLABORATION FOCUSED ON BROADENING THE KNOWLEDGE OF GERIATRIC EMERGENCY CARE. TOPICS FOR GEDC-HOSTED WEBINARS INCLUDED FRAILTY IN THE GERIATRIC EMERGENCY DEPARTMENT, GERIATRIC EMERGENCY NURSE MANAGEMENT, AND CARING FOR RURAL COMMUNITIES IN THE GED. THIS PARTNERSHIP HAS ALLOWED THE CONTINUED SHARED KNOWLEDGE AND EXPERTISE AMONG CLINICAL TEAMS LOOKING TO IMPROVE CARE FOR OLDER ADULTS IN THE EMERGENCY DEPARTMENT. THE COLLABORATION ALSO FOSTERED CONTINUED BOOTCAMP ACTIVITIES, TRAINING AND DEVELOPING NEW NATIONAL GED SITES. EXPANDING GED ADOPTION ACROSS THE VETERANS' HEALTH SYSTEM AND ENSURING PROGRAM SUSTAINABILITY SINCE THE INITIATION OF OUR PARTNERSHIP WITH THE VETERANS HEALTH ADMINISTRATION (VHA) AND THE INDIANA INSTITUTE FOR MEDICAL RESEARCH (IIMR), THE VA HEALTH SYSTEM HAS BEEN CELEBRATED AS THE MOST ACCREDITED (FOR GEDS) INTEGRATED HEALTH CARE SYSTEM. IN THE FIRST HALF OF 2023, THE VA AND WHI FINALIZED A GED SYSTEMWIDE SUSTAINABILITY PLAN AND SUBMITTED ALL PENDING GED APPLICATIONS FROM A TOTAL OF 70 SITES. ALSO IN 2023, THE INSTITUTE AND THE VA NATIONAL EMERGENCY MEDICINE OFFICE INITIATED A NEW PHASE OF WORK, SUPPORTED BY THE IIMR, DEVELOPING AND DISSEMINATING A CASE STUDY DEMONSTRATING SEAMLESS ALIGNMENT OF THE GED MODEL WITH HIGHER LEVEL VA STRATEGIC GOALS. THIS STUDY FOUND THAT STAFF VIEW GED IMPLEMENTATION AS A NECESSARY TOOL THAT ENABLED THEM TO PROVIDE BETTER CARE THAT WOULD NOT HAVE BEEN POSSIBLE OTHERWISE. THE INSTITUTE PROVIDED RESEARCH SUPPORT TO THE VA GED CORE TEAM FOR DATA COLLECTION, ANALYSIS, INTERPRETATION OF RESULTS, AND CO-AUTHORSHIP OF ALL RESEARCH PRODUCTS. FURTHER DISSEMINATION OUTLETS TARGETED INTERNAL VA LEADERSHIP, EXTERNAL EXECUTIVES, VA STAFF, THE GED COMMUNITY, AND OLDER VETERANS. FINAL PRODUCTS INCLUDED A VA STAFF WEBINAR, SAEM RESEARCH FORUM ABSTRACT AND PRESENTATION, VA PODCAST, VA NEWSLETTER, AND FINAL BUSINESS CASE DOCUMENT. SHARP HEALTHCARE (SHARP): CHANGING HOSPITAL CULTURE THROUGH GENERATIONAL HEALTH WHILE WE AIM TO AVOID UNNECESSARY ADMISSIONS FOR OLDER ADULTS, THERE ARE TIMES WHEN HOSPITAL CARE IS ESSENTIAL. IN CASES OF TRAUMA, WHEN OLDER ADULTS ARE ESPECIALLY AT RISK OF SIGNIFICANT LOSS OF MOBILITY AND DECREASED QUALITY OF LIFE, GERIATRIC-SPECIFIC STRATEGIES HAVE AN IMPORTANT ROLE IN ENSURING THE HIGHEST STANDARDS OF CARE ARE ACHIEVED. THE INSTITUTE PARTNERED WITH SHARP HEALTHCARE (AND SHARP MEMORIAL HOSPITAL IN PARTICULAR) TO CATALYZE THEIR EFFORTS IN GERIATRIC TRAUMA THAT HAVE EXTENDED HOSPITAL-WIDE THROUGH A PROGRAM CALLED GENERATIONAL HEALTH. THE INSTITUTE COLLABORATED WITH SHARP TO DEVELOP A TOOLKIT TO SUPPORT OTHER HOSPITALS AND SYSTEMS IN IMPLEMENTING MULTIDISCIPLINARY PROGRAMS AND TO DISSEMINATE THEIR LEARNINGS THROUGHOUT CLINICAL AND RESEARCH COMMUNITIES. TRACKING OF PROCESS AND PATIENT OUTCOMES OVER THE YEAR ALLOWED FOR ASSESSMENT OF HOW SHARP'S STRATEGY IS IMPROVING PATIENT OUTCOMES AND OPPORTUNITIES FOR IMPROVEMENT. A COMPREHENSIVE OUTCOMES DOCUMENT WAS JOINTLY CREATED THAT WILL FEED INTO A CASE STUDY AND THE DESIGN OF A COLLABORATIVE RESEARCH STUDY IN 2024. CONVENING A LEARNING AND ACTION NETWORK TO ENABLE ALIGNED PARTNERSHIPS BETWEEN GEDS AND VALUE-BASED CARE ORGANIZATIONS (VBCO) BECAUSE VBCO'S ENGAGE IN VALUE-BASED PAYMENT MODELS OFFERED BY BOTH GOVERNMENT AND COMMERCIAL PAYORS, THEY HAVE A SPECIFIC INCENTIVE TO REDUCE AVOIDABLE HOSPITAL ADMISSIONS. HOWEVER, INITIAL RESEARCH CONDUCTED IN 2023 ALSO REVEALED THERE WAS NOT WIDESPREAD AWARENESS OF THE MUTUAL INTERESTS OF GEDS AND VBCOS, LET ALONE AN UNDERSTANDING OF HOW TO RIGOROUSLY ENGAGE IN CARE REDESIGN PROCESSES TO REALIZE THE POTENTIAL BENEFITS OF PARTNERSHIPS. FOR THESE REASONS AND MORE, WE DEVELOPED A PLAN TO SYSTEMATICALLY IMPROVE CARE AND LOWER COSTS FOR OLDER ADULTS BY FOSTERING MEANINGFUL VCBO/GED RESEARCH PARTNERSHIPS. IN 2023, WE LAUNCHED A SUCCESSFUL RESEARCH COLLABORATION WITH FOUR HEALTH SYSTEM GEDS INCLUDING ADVOCATE HEALTH CARE, UNIVERSITY OF NORTH CAROLINA (UNC HEALTH CARE), CLEVELAND CLINIC, AND CARE NEW ENGLAND HEALTH SYSTEM (WORKED WITH BOTH KENT HOSPITAL AND INTEGRA COMMUNITY CARE NETWORK) TO CULTIVATE PARTNERSHIPS WITH VBCOS (ACCOUNTABLE CARE ORGANIZATIONS AND CLINICALLY INTEGRATED NETWORKS) WHOSE PATIENTS WERE BEING CARED FOR IN GEDS. COMMUNICATION AND QUALITY IMPROVEMENT ACTIVITIES ARE PART OF AN ONGOING INVESTIGATION. A WHI TOOLKIT WAS DEVELOPED TO SERVE AS A GUIDE TO THE PARTICIPATING ORGANIZATIONS. ACUTE CARE RESEARCH AREA: VALUE-BASED ACUTE CARE AT HOME RESEARCH COLLABORATIONS WITH HOSPITAL SYSTEMS AND PROVIDERS IN 2023, WHI COMPLETED THE FINAL ANALYSIS OF OUR VALUE-BASED ACUTE CARE AT HOME ENGAGEMENT WITH INTEGRA COMMUNITY CARE NETWORK, UNITYPOINT HEALTH, HEALTHPARTNERS, AND THE VISITING NURSE ASSOCIATION HEALTH GROUP. AT THE END OF THE COLLABORATION, THE TEAMS COLLECTIVELY AVERTED 456 EMERGENCY DEPARTMENT VISITS AND 459 HOSPITALIZATIONS WITH AN ESTIMATED NET SAVINGS OF OVER 4.9 MILLION DOLLARS. IN ADDITION, WE COLLABORATED IN A RESEARCH ENGAGEMENT WITH HEALTHTOPIA CLINICS, AN INDEPENDENT PRIMARY, URGENT, AND INTEGRATIVE CARE PHYSICIAN PRACTICE COMMITTED TO DISRUPTING THE COSTLY CARE DELIVERY PROCESSES, PARTICULARLY FOR COMPLEX OLDER PATIENTS. OUR INVESTIGATION REVEALED THE AVAILABILITY OF OPTIONS FOR MAINTAINING ADEQUATE AUTONOMY WHILE JOINING FORCES WITH LARGER ADMINISTRATIVE ENTITIES TO GET MORE PREDICTABLE FINANCIAL RESULTS INCLUDING LESS EXPOSURE TO CATASTROPHIC OUTLIERS. DATA SCIENCE: NATIONAL CLAIMS DATA ANALYSIS IN SUPPORT OF CARE REDESIGN DIRECTED TOWARD VALUE-BASED ACUTE CARE AT HOME IN SUPPORT OF DEVELOPING EVIDENCE-BASED MODELS FOR VBC ACUTE CARE AT HOME, WHI ENGAGES SIGNIFICANTLY IN CHARACTERIZING THE NATURE OF ACUTE CARE UTILIZATION BROADLY. IN 2023, WHI COLLABORATED WITH HEALTHCARE PROVIDER PRESIDIUM HEALTH TO PRESENT A TALK AT THE AMERICAN ACADEMY OF HOME CARE MEDICINE (AAHCM) ENTITLED, "THEORY AND PRACTICE OF LONGITUDINAL HOME CARE MEDICINE FOR HIGH NEED, COMPLEX POPULATIONS IN VALUE BASED PAYMENT MODELS." ALONG SIMILAR LINES, WHI WORKED WITH THE INSTITUTE FOR ACCOUNTABLE CARE (IAC) TO PUBLISH AN ARTICLE ENTITLED "CHALLENGES IN PREDICTING FUTURE HIGH-COST PATIENTS FOR CARE MANAGEMENT INTERVENTIONS." DEVELOPMENT OF A CONCEPTUAL FRAMEWORK FOR ACUTE CARE AT HOME WITHIN A FLEXIBLE CONTINUUM OF CARE WHI ALSO ENGAGED IN A STUDY OF THE POST-DISCHARGE HOME VISIT WAIVER (PDHV), A BENEFIT AVAILABLE IN SOME MEDICARE VALUE-BASED PAYMENT PROGRAMS. OUR COLLABORATION WAS SPECIFICALLY DIRECTED TO AN AMBULATORY CARE TEAM AT UNITYPOINT HEALTH. THE PDHV WAIVER SPECIFICALLY ALLOWED DESIGNATED CLINICIANS SUCH AS NURSES TO VISIT PATIENTS IN THEIR HOMES, FOLLOWING A HOSPITAL-BASED EPISODE OF CARE, INCLUDING AN ED VISIT. IN THIS INVESTIGATION, IT BECAME CLEAR THAT STRONGER REFERRAL PATHWAYS WOULD NEED TO BE DEVELOPED BEFORE A SYSTEMATIC DETECTION OF CHANGE IN STATUS COULD BE EXPECTED. IN PARTNERSHIP WITH OUR COLLABORATORS AT THE INTEGRA COMMUNITY CARE NETWORK ACO AND CARE NEW ENGLAND HEALTH SYSTEM, WE DEVELOPED AN IN-DEPTH NARRATIVE OF THIS CONCEPTUAL FRAMEWORK IN AN ARTICLE PUBLISHED IN THE JOURNAL OF THE AMERICAN GERIATRIC SOCIETY (JAGS) AND ENTITLED "INTEGRA AT HOME: A FLEXIBLE CONTINUUM OF IN-HOME MEDICAL CARE FOR OLDER ADULTS WITH COMPLEX NEEDS". SENIOR-APPROPRIATE CHRONIC CARE RESEARCH SYSTEMATICALLY ADDRESSING THE ONGOING COMPLEX MEDICAL, BEHAVIORAL, AND SOCIAL NEEDS OF OLDER ADULTS IN A COST-EFFECTIVE MANNER WHILE ENSURING THAT WHAT MATTERS MOST TO THEM IS ACCOUNTED FOR REPRESENTS AN IMPORTANT PART OF THE INSTITUTE'S RESEARCH. THESE ACTIVITIES COVER A VARIETY OF AREAS. CHRONIC CARE RESEARCH AREA: EVALUATING OPTIMIZED CARE IN THE PACE SETTING THE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) IS A FEDERAL AND STATE FUNDED AND REGULATED PROGRAM. PACE PROGRAMS ARE REGISTERED AS HEALTH SYSTEMS - THAT PROVIDE 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 HAS ADVANCED AN INNOVATIVE PROGRAM OF APPLIED MEDICAL RESEARCH STUDIES IN PARTNERSHIP WITH PACE (INCLUDING THE GARY AND MARY WEST PACE (GMWP) PROGRAM IN SAN MARCOS, CA ALSO KNOWN AS GARY AND MARY WEST SENIOR SERVICES) TO BETTER UNDERSTAND AND EXPLORE HOW CARE CAN BE INCREASINGLY DELIVERED WITH HIGH EFFICIENCY (INCLUDING COST EFFICIENCY) AND QUALITY. BUILDING SYSTEMS TO GATHER DATA AND TEST HYPOTHESES (POPULATION HEALTH RESEARCH DASHBOARDS)
FORM 990, PART III, LINE 4A, (CONTINUATION):	HISTORICALLY, PACE PROGRAMS HAD A DIFFICULT TIME COLLECTING AND USING DATA TO INFORM DECISION-MAKING BOTH ON THE CLINICAL AND OPERATIONAL SIDES, LARGELY DUE TO INFORMATION BEING SILOED IN ONE OF MANY (OFTEN 7-10) DIFFERENT DATABASES. OUR RESEARCH HYPOTHESIS IS THAT BRINGING TOGETHER DATA FROM A VARIETY OF DATABASES INTO ONE SYSTEM, AND ORGANIZING DATA IN MORE USEFUL WAYS, WHICH WILL ALLOW PACE PROGRAM DECISIONMAKERS AND PROVIDERS TO ACCESS JUST-IN-TIME METRICS IN AN EASY-TO-CONSUME MANNER, SHOULD ENABLE PACE CLINICAL AND ADMINISTRATIVE STAFF TO BETTER CHARACTERIZE AREAS OF NEED, AND DELIVER TARGETED SERVICES MORE EFFICIENTLY AND EFFECTIVELY. IN 2023, WHI STUDIED A ROBUST DATA DASHBOARD CAPABILITY WHICH WAS CREATED FOR GMWP, SPECIFICALLY A SUITE OF STATIC AND DYNAMIC DASHBOARDS SUITABLE FOR ALMOST EVERY TYPE OF STAFF AND PROVIDER ROLE. THIS CAPABILITY TAKES THE SOLUTION BEYOND DASHBOARDS AND GIVES USERS THE ABILITY TO CREATE AND VISUALIZE HUNDREDS OF METRICS SPECIFIC TO THEIR OWN NEEDS. BY Q4 OF 2023, GMWP LEADERS WERE USING THIS PRODUCT/SOLUTION ON A REGULAR BASIS TO INFORM THEIR DECISION MAKING AND LEVERAGING RESEARCH AND INSIGHTS BY WHI TO OPTIMIZE THE DESIGN AND FUNCTIONALITY. REACHING THIS POINT WAS CRITICAL TO TESTING THE HYPOTHESIS THAT MAKING PACE DATA MORE USABLE WILL POSITIVELY IMPACT DECISION MAKING AND BEHAVIORS. QUALITY IMPROVEMENT (QI) RESEARCH DIRECTED TO DISCOVERING AND TESTING NEW INTERVENTIONS FOR REDUCING HIGH-COST LOW-VALUE INSTITUTIONAL-BASED SERVICES AN IMPORTANT AREA OF INVESTIGATION WITHIN A PACE MODEL IS CREATING OPPORTUNITIES AND METHODS TO DELIVER AND STUDY CARE IN-PLACE WHERE SENIORS LIVE (AND TO DO SO IN A COSTEFFECTIVE, SUSTAINABLE MANNER). THROUGHOUT 2023, WHI ADVANCED ITS VALUE-BASED CARE RESEARCH WITHIN PACE. THIS PARTICULAR RESEARCH COLLABORATION WITH GMWP INVESTIGATED AND GENERATED EVIDENCE OF LOWER COSTS AND SUSTAINABLE MODELS THAT BETTER MATCHED SERVICES TO THE NEEDS OF PACE VULNERABLE OLDER ADULTS EXPERIENCING UNSCHEDULED HEALTH EVENTS. MUCH OF THE RESEARCH CENTERED ON PROACTIVE PATIENT ENGAGEMENT AND AGILE RESPONSES TO UNPLANNED ACUTE EVENTS. THE SPECIFIC AIMS FOR THE 2023 GMWP RESEARCH WERE TO DEPLOY AND MEASURE METHODS DESIGNED TO REDUCE HOSPITALIZATIONS AND ED VISITS, ENABLING PARTICIPANTS TO REMAIN IN THEIR HOMES AND COMMUNITIES, AND TO ADVANCE THE FINANCIAL SUSTAINABILITY OF THE PACE MODEL. AS PART OF THE ABOVE, WHI STUDIED A GMWP INITIATIVE TO INTERCEPT PARTICIPANTS' NON-LIFETHREATENING MEDICAL CONCERNS USING A MOBILE HEALTH SERVICE. THE STUDY WAS STRUCTURED AS A QI INVESTIGATION AND WAS DESIGNED TO TRACK THE TYPES OF MOBILE NURSING ENCOUNTERS (E.G., SCHEDULED, ON-DEMAND, URGENT) AND DETERMINE IF A VISIT TO THE ED WAS AVERTED. BY THE END OF 2023, GMWP REPORTED A DECREASE IN ED COSTS OF APPROXIMATELY $20 PER MEMBER PER MONTH AND OVER $400 PER MEMBER PER MONTH IN HOSPITAL COSTS. TESTING ADVANCED CARE PLANNING (GOALS OF CARE) PACE PROVIDERS MUST MEET THE VARIED NEEDS OF MEDICALLY COMPLEX OLDER ADULTS, WHICH INCLUDES ADVANCE CARE PLANNING. ADVANCE CARE PLANNING (ACP) IN PACE PROGRAMS IS OFTEN NARROWLY TARGETED TO END-OF-LIFE DECISIONS. HOWEVER, A GROWING BODY OF RESEARCH SUGGESTS THAT UNDERSTANDING PATIENTS' BROADER GOALS OF CARE (GOC), WHICH INCLUDES DECISIONS FOR END-OF-LIFE, CAN LEAD TO CARE THAT IS MORE CONCORDANT WITH THEIR PREFERENCES, HIGHER COMPLIANCE WITH HEALTH REGIMENS, AND GREATER PARTICIPANT AND FAMILY SATISFACTION. IN 2023, WHI FOCUSED ON WORKING CLOSELY WITH SEVERAL SERVICE LINES AT GMWP TO STUDY AND EVALUATE TASKS KEY TO ACP INCLUDING IDENTIFICATION AND DOCUMENTATION IN THE ELECTRONIC MEDICAL RECORD OF 1) A MEDICAL DECISION MAKER, 2) PHYSICIAN ORDERS FOR LIFE- SUSTAINING TREATMENT (POLST)ELECTIONS, AND 3) GOC CONVERSATIONS. BETWEEN 2022 AND 2023, THIS WORK HAS RESULTED IN VAST IMPROVEMENTS TO ACP. ASSESSING PACE PROGRAMS' DELIVERY OF BEHAVIORAL HEALTH SERVICES IN 2023, WEST HEALTH INSTITUTE WORKED WITH A RESEARCH TEAM AT COLUMBIA UNIVERSITY HEALTH TO DOCUMENT AND EVALUATE HOW PACE PROGRAMS DELIVER BEHAVIORAL HEALTH (BH) SERVICES, IN PARTICULAR STUDYING A MODEL OF BEHAVIORAL HEALTH INTEGRATION WITHIN PRIMARY CARE THAT COULD, IF DEPLOYED WITHIN PACE PROGRAMS, GREATLY IMPROVE CLINICAL OUTCOMES. AS PART OF THIS WORKSTREAM, THE TEAM CREATED AND DEPLOYED A SURVEY ABOUT BEHAVIORAL HEALTH NEEDS AND SERVICES TO ALL PACE PROGRAMS. FOLLOWING THIS SURVEY, THE STUDY TEAM HELD IN-DEPTH INTERVIEWS WITH APPROXIMATELY A DOZEN SITES. THIS WORK LED TO PUBLICATION OF A PAPER IN THE JOURNAL OF THE AMERICAN GERIATRICS SOCIETY JOURNAL THAT DOCUMENTED AND DISSEMINATED THE FINDINGS FROM THESE ENDEAVORS. IN PARTICULAR, THE FINDINGS WERE THAT IN THE ABSENCE OF PACE-SPECIFIC BH DELIVERY GUIDELINES AND GUIDANCE FROM THE FEDERAL OR STATE LEVEL FOR PACE PROGRAMS, BH SERVICE INCLUSION HAS BEEN DEVELOPED UNEVENLY ACROSS PACE ORGANIZATIONS. ASSESSING THE LANDSCAPE OF BH INCLUSION ACROSS PACE ORGANIZATIONS, WHICH IS WHAT THE TEAM DID, IS A STEP TOWARD EVIDENCE-BASED AND STANDARDIZED INCLUSION OF BH WITHIN THE ALL-INCLUSIVE CARE MODEL. ADDITIONALLY, IN 2023, THE TEAM CREATED WORKFLOWS AND TOOLS FOR INTEGRATING BEHAVIORAL HEALTH WITHIN PACE ORGANIZATIONS. SENIOR-APPROPRIATE TELEHEALTH RESEARCH GIVEN THE ENDURING INCREASE IN USE OF TELEHEALTH WITH THE SENIOR POPULATION IN THE WAKE OF THE PANDEMIC, WHI HAS SOUGHT TO ENSURE THAT TELEHEALTH IS DELIVERED IN A MANNER THAT IS "AGE-INCLUSIVE" IN THAT IT ACCOUNTS FOR OLDER ADULTS' UNIQUE NEEDS. TO SUPPORT RESEARCH AND EVALUATION OF AGE-INCLUSIVE TELEHEALTH PROGRAMS, WEST HEALTH INSTITUTE PARTNERED WITH THE UNIVERSITY OF VIRGINIA HEALTH SYSTEM DEPARTMENT OF GERIATRICS AND THE MID- ATLANTIC TELEHEALTH RESOURCE CENTER TO CREATE (1) THE COLLABORATIVE FOR TELEHEALTH AND AGING, AND (2) THE CENTER OF EXCELLENCE FOR TELEHEALTH AND AGING. IN 2023, WHI FOCUSED ON INCREASING THE RELEVANCE, CREDIBILITY, AND VISIBILITY OF THIS INITIATIVE. A KEY PRIORITY WAS LAUNCHING THE AGE-INCLUSIVE TELEHEALTH PLEDGE CAMPAIGN, TO BROADLY DRIVE THE ADOPTION AND IMPLEMENTATION OF THE PRINCIPLES AND GUIDELINES IN HOSPITALS AND HEALTH SYSTEMS. THIS EFFORT HAS GARNERED SUPPORT FROM OVER 50 ORGANIZATIONS. WHI ALSO DEVELOPED RESOURCES TO SUPPORT HEALTHCARE PROVIDERS IN IMPLEMENTING AGE-INCLUSIVE TELEHEALTH PRACTICES. THESE INCLUDED THE TELEHEALTH EQUITY TOOLKIT, SIX CASE STUDIES AND PROGRAM WRITE-UPS SHOWCASING SUCCESSFUL IMPLEMENTATION, AND A VIDEO TESTIMONIAL SERIES HIGHLIGHTING THE IMPACT OF THESE PRACTICES. ADDITIONALLY, WHI LAUNCHED AN AWARD TO RECOGNIZE INNOVATIVE AGE-INCLUSIVE TELEHEALTH PROGRAMS.
FORM 990, PART III, LINE 4B	COST OF HEALTHCARE AMERICA'S HEALTH CARE COST CRISIS REMAINS A PRESSING ISSUE FOR OLDER ADULTS AND THE NATION AT LARGE. THE US HEALTH SYSTEM CONTINUES TO LEAD THE WORLD IN COST, WHILE CONTINUING TO UNDERPERFORM IN TERMS OF OUTCOMES AND PATIENT SATISFACTION. IN 2023, THE GARY AND MARY WEST HEALTH INSTITUTE (WHI OR INSTITUTE) REMAINED COMMITTED TO PLAYING AN IMPORTANT ROLE IN CONDUCTING APPLIED MEDICAL RESEARCH TO HELP PROVIDE UNBIASED AND RELIABLE DATA AND FINDINGS THAT ENABLE STAKEHOLDERS IN THE US HEALTH SYSTEM TO CHART A COURSE TO HEALTHCARE THAT IS MORE AFFORDABLE AND ULTIMATELY A BETTER VALUE FOR OLDER ADULTS IN AMERICA. THE WEST HEALTH INSTITUTE'S AREAS OF FOCUS IN ADDRESSING THE COST OF HEALTHCARE OVER THE PAST YEAR CONTINUED TO BE CENTERED AROUND CONDUCTING RESEARCH AND SHARING STATISTICS THAT CAN BE USED IN RAISING AWARENESS ABOUT THE SIZE AND URGENCY OF THIS ISSUE, LOWERING PRESCRIPTION DRUG PRICES, AND INCREASING PRICE TRANSPARENCY WITH A GOAL OF HIGHLIGHTING, AND EVENTUALLY ENABLING THE REDUCTION OF, OUT-OF-CONTROL HEALTHCARE SERVICE PRICING. KEY TO THIS WORK WAS OUR CONSTRUCTIVE COLLABORATIONS WITH LIKE-MINDED, HIGHLY RESPECTED ORGANIZATIONS, INCLUDING BUT NOT LIMITED TO THE DUKE-MARGOLIS CENTER FOR HEALTH POLICY, US OF CARE, THE GEORGETOWN CENTER FOR HEALTH INSURANCE REFORM, FAMILIES USA, THE NATIONAL ACADEMY FOR STATE HEALTH POLICY, HEALTH MANAGEMENT ASSOCIATES, THE PURCHASER BUSINESS GROUP ON HEALTH, AND THE HEALTHCARE COST INSTITUTE (HCCI). GENERATE DATA THAT HIGHLIGHTS TO THE NATURE AND MAGNITUDE OF THE HEALTH SPENDING CRISIS TO FOCUS THE ATTENTION OF POLICYMAKERS, ADMINISTRATORS, AND THE GENERAL PUBLIC ON THE HEALTHCARE CRISIS, WHI UNDERTOOK A VARIETY OF KEY PUBLIC AND POLICYMAKER EDUCATION AND AWARENESS STRATEGIES IN 2023. WE COLLABORATED ON PUBLIC POLLING ACTIVITIES AT THE STATE AND NATIONAL LEVEL WITH GALLUP AND OTHERS. WE CONTINUED TO SHINE LIGHT ON THE STRUGGLE TO PAY FOR HEALTHCARE FACED BY A LARGE PORTION OF THE NATION, AND ALSO ON THE SACRIFICES BEING MADE TO AFFORD CARE. TWO COMPOSITE INDICES WERE LEVERAGED AS PART OF THIS POLLING/AWARENESS WORK: THE WEST HEALTH-GALLUP HEALTHCARE AFFORDABILITY INDEX AND HEALTHCARE VALUE INDEX. THE HEALTHCARE AFFORDABILITY INDEX ASSESSES THE PUBLIC'S ABILITY TO AFFORD THE HEALTHCARE THEY NEED, WHILE THE HEALTHCARE VALUE INDEX SYNTHESIZES AMERICANS' PERCEPTIONS OF THE QUALITY OF CARE RELATIVE TO COST. IN 2023, WHI HAD A HIGHLY SUCCESSFUL RELEASE RELATED TO SAFETY AND QUALITY OF CARE IN NURSING HOMES AND WE CONTINUED TO SHINE A LIGHT ON THE BURDEN OF HIGH HEALTHCARE COSTS ON THE AMERICAN PEOPLE THROUGH OUR SURVEYS. WE ALSO RELEASED THE WEST HEALTH-GALLUP DATA DASHBOARD, WHICH SERVES AS A TOOL FOR ELECTED OFFICIALS, POLICYMAKERS, AND THE PUBLIC TO BETTER UNDERSTAND THE CHANGING ATTITUDES AND BEHAVIORS TOWARD HEALTHCARE, AND WHAT NEEDS TO BE DONE TO AVOID PUTTING THE HEALTH OF MILLIONS OF AMERICANS AT RISK. CONTINUE TO DEVELOP UNDERSTANDING OF HEALTHCARE COST AND AGING ISSUES AT STATE AND NATIONAL LEVELS AND POLICY FIXES WHI CONTINUED TO ADVANCE COLLABORATIONS PRODUCING RESEARCH DESIGNED TO HIGHLIGHT PATHS FORWARD FOR POLICYMAKERS TO CONSIDER HOW TO BEND THE HEALTH COST CURVE. THESE ACTIVITIES INCLUDED: - ROUNDTABLE CONVERSATION AND ANALYSIS AROUND REFORMS TO THE PHARMACY BENEFIT MANAGER (PBM) SYSTEM TO FIND POLICIES THAT BOTH PROTECT THEIR ABILITY TO NEGOTIATE DISCOUNTS WHILE ENSURING THAT THOSE DISCOUNTS ARE PASSED TO PAYERS AND PATIENTS - LAUNCH OF AN ACADEMY TO ENGAGE TEAMS OF STATE LEADERS FROM SIX STATES TO WORK WITH PEERS AND EXPERTS TO IDENTIFY AND SHARE STRATEGIES AND SOLUTIONS FOR IMPROVEMENT AGING POLICY - PARTNERING WITH THE DUKE-MARGOLIS CENTER FOR HEALTH POLICY TO PURSUE ACTIONABLE STRATEGIES TO SPREAD AND SCALE VALUE-BASED CARE ACROSS THE COUNTRY. THIS COLLABORATION IDENTIFIED OPPORTUNITIES TO EXPAND HOME-BASED CARE IN MEDICARE AND VIA CENTERS FOR MEDICARE AND MEDICAID INNOVATION (CMMI) MODELS - COLLABORATION WITH THE HEALTH CARE COST INSTITUTE (HCCI) ON ANALYSES OF COMMERCIAL HEALTH INSURANCE CLAIMS THAT HIGHLIGHTED HIGH PROVIDER PRICING AND EXPLORATION OF WAYS THAT EMPLOYERS AND POLICYMAKERS COULD ENGAGE MORE TO LOWER HEALTHCARE SPENDING ON EMPLOYER-BASED INSURANCE
FORM 990, PART VI, SECTION A, LINE 2	THE MAJORITY 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 PREFORMED BY EMPLOYEES OF GARY AND MARY WEST MANAGEMENT COMPANY, INC. SALLY HALLAK AND JONATHAN ZIFFERBLATT 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 $1,069,793.
FORM 990, PART VI, SECTION A, LINE 4	ON SEPTEMBER 21, 2023, THE BOARD OF DIRECTORS APPROVED AMENDING AND RESTATING THE BYLAWS. THE KEY CHANGES OF THE AMENDED BYLAWS INCLUDE: 1) UPDATE OF "PURPOSES" SECTION, 2) UPDATED THE PERMANENT MEMBER AS THE GARY AND MARY WEST CHARITABLE TRUST, DBA GARY AND MARY WEST FOUNDATION, 3) ADDED REQUIREMENT FOR 80% OF MEMBERS TO APPROVE CHANGES TO THE NUMBER OF MEMBERS, 4) ADDED REQUIREMENT THAT FOR A QUORUM TO EXIST, THE PERMANENT MEMBER MUST BE PRESENT, 5) ADDED A RESTRICTION OF THE BOARD OF DIRECTORS TO BE NO MORE THAN 5 MEMBERS, 6) ADDED REQUIREMENT FOR DIRECTORS TO BE APPOINTED BY AN 80% VOTE OF THE MEMBERS, 7) ALLOW FOR BOARD OF DIRECTORS TO ACT UPON A 2/3 MAJORITY VOTE, 8) REMOVED THE ROLE OF "EXECUTIVE VICE PRESIDENT", 9) ADDED DEFINITION OF THE WORD "SENIORS". ON OCTOBER 16, 2023 THE CERTIFICATE OF INCORPORATION OF WHI WAS AMENDED AND RESTATED. THE KEY CHANGES TO THE CERTIFICATE OF INCORPORATION INCLUDE: 1) UPDATE OF WHI'S SPECIFIC PURPOSES, 2) INCREASE THE VOTES NEEDED TO DISSOLVE THE CORPORATION OR AMEND THE CERTIFICATE, 3) ADD EDUCATIONAL TO THE LIST OF PURPOSES FOR WHICH ASSETS MAY BE DISTRIBUTED UPON DISSOLUTION, 4) REDUCE THE MAXIMUM NUMBER OF DIRECTORS, 5) GRANT DIRECTORS THE POWER TO MAKE AND CHANGE BYLAWS AND INCREASE THE VOTE NEEDED TO AMEND BYLAWS.
FORM 990, PART VI, SECTION A, LINE 6	THE ORGANIZATION IS A NON-PROFIT, NON-STOCK CORPORATION WITH THREE MEMBERS DURING 2023. ONE INSTITUTIONAL MEMBER DESIGNATED AS A PERMANENT MEMBER, THE GARY AND MARY WEST CHARITABLE TRUST AND TWO NON-INSTITUTIONAL MEMBERS WHICH ARE ELECTED AND TERM-BASED MEMBERS, JAMES K HASSON AND THOMAS CULHANE.
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 CFO, 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 2023 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, WHEN APPLICABLE. 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 COMPENSATION COMMITTEE AND 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 2024.
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 VARIOUS SENIOR MANAGEMENT ROLES.
FORM 990, PART IX, LINE 11G	OTHER CONSULTANTS: PROGRAM SERVICE EXPENSES 2,768,940. MANAGEMENT AND GENERAL EXPENSES 1,427,248. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,196,188. RESEARCH STUDIES: PROGRAM SERVICE EXPENSES 4,368,735. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,368,735. OTHER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 693. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 693. STAKEHOLDER COMMUNICATIONS: PROGRAM SERVICE EXPENSES 39,280. MANAGEMENT AND GENERAL EXPENSES 33,459. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72,739.

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

Cat. No. 51056K

Schedule O (Form 990) 2023

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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

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

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

Cat. No. 50135Y

Schedule R (Form 990) 2023

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) GARY AND MARY WEST MANAGEMENT COMPANY INC 4960 AVENIDA ENCINAS CARLSBAD,CA92008 45-4040871	SEE SCH R, PART VII	DE	N/A	C					No

Schedule R (Form 990) 2023

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) ............................

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) 2023

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2023

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation
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: 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 ADMINISTRATIVE SUPPORT SERVICES. PRIMARY ACTIVITY: PROVIDING ADMINISTRATIVE SUPPORT SERVICES.

Schedule R (Form 990) 2023

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	5
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	3
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	28
6	Total number of volunteers (estimate if necessary) .............	6	6
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	17,407,144	20,989,001
9	Program service revenue (Part VIII, line 2g) .........	0	0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-4,340	167,669
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	75,437	84,471
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	17,478,241	21,241,141
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	7,283	6,893
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)	5,414,013	5,630,114
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)....	15,778,650	15,491,918
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	21,199,946	21,128,925
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,721,705	112,216
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	17,273,627	15,616,066
21	Total liabilities (Part X, line 26).............	16,188,932	14,419,155
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,084,695	1,196,911

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 14,560,701 including grants of $ 6,893 ) (Revenue $ )
	SEE SCHEDULE O.

4b	(Code: ) (Expenses $ 218,831 including grants of $ ) (Revenue $ )
	SEE SCHEDULE O.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses14,779,532

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) SHELLEY M LYFORD...................................................................... DIRECTOR, CHAIR & CEO	30.00 ................. 5.00	X	X		829,386	0	20,356
(2) CHARLES SEDERSTROM...................................................................... DIRECTOR	5.00 ................. 1.00	X			0	0	0
(3) GARY WEST...................................................................... DIRECTOR	5.00 ................. 5.00	X			0	0	0
(4) MARK MCCLELLAN...................................................................... DIRECTOR	5.00 ................. 5.00	X			0	0	0
(5) NICK VALERIANI...................................................................... DIRECTOR	5.00 ................. 5.00	X			0	0	0
(6) ZIA AGHA...................................................................... CMO & EVP CLINICAL RESEARCH	40.00 .................		X		772,492	0	76,914
(7) TIMOTHY LASH...................................................................... PRESIDENT	30.00 ................. 10.00		X		721,307	0	58,219
(8) JONATHAN ZIFFERBLATT...................................................................... CHIEF STRATEGY OFFICER	40.00 ................. 10.00		X		0	565,650	59,987
(9) SALLY HALLAK...................................................................... CFO, SECRETARY AND TREASURER	30.00 ................. 10.00		X		0	504,143	34,330
(10) LIANE WARDLOW...................................................................... SENIOR DIRECTOR, CLINICAL RESEARCH	40.00 .................			X	245,685	0	40,189
(11) AMY STUCK...................................................................... SENIOR DIRECTOR, VALUE-BASED ACUTE	40.00 .................			X	223,509	0	55,165
(12) CHRISTOPHER CROWLEY...................................................................... PROGRAM MANAGER	40.00 .................			X	239,963	0	34,965
(13) ADRIAN KWONG...................................................................... PRINCIPAL DATA SECURITY ARCHITECT	40.00 .................			X	221,701	0	32,632
(14) HAW-MINN LU...................................................................... PRINCIPAL DATA SCIENTIST	40.00 .................			X	205,020	0	48,855

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	3,459,063	1,069,793	461,612

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

f	All other contributions, gifts, grants, and similar amounts not included above		1f	20,989,001

g	Noncash contributions included in lines 1a - 1f:$		1g	1,000

h Total. Add lines 1a-1f.......		20,989,001

		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) ......			167,669			167,669
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	84,471
b	Less: rental expenses	6b	0
c	Rental income or (loss)	6c	84,471
d	Net rental income or (loss).......			84,471			84,471
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a
b	Less: cost or other basis and sales expenses	7b
c	Gain or (loss)	7c
d	Net gain or (loss).........
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
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			21,241,141	0	0	252,140

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	6,893	6,893
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 ...........	2,019,624	1,606,526	413,098
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	2,937,411	2,564,436	372,975
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	127,007	127,007
9	Other employee benefits .......	279,712	272,657	7,055
10	Payroll taxes ...........	266,360	220,406	45,954
11	Fees for services (non-employees):
a	Management ......	2,201,024	520,542	1,680,482
b	Legal .........	49,880	11,118	38,762
c	Accounting ...........	96,653		96,653
d	Lobbying ...........	216,000	216,000
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)	8,638,355	7,176,955	1,461,400
12	Advertising and promotion ....
13	Office expenses .......	7,570	1,358	6,212
14	Information technology ......	746,578	133,732	612,846
15	Royalties ..
16	Occupancy ...........	2,562,596	1,410,799	1,151,797
17	Travel ............	180,711	144,965	35,746
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	38,118	33,568	4,550
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	122,107	63,605	58,502
23	Insurance ...	95,993		95,993
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	244,179	150,628	93,551
b	SUBSCRIPTIONS/PUBS/DATA	146,416	64,522	81,894
c	RECRUITING/RETENTION	72,960	6,660	66,300
d	OTHER EXPENSES	72,778	47,155	25,623
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	21,128,925	14,779,532	6,349,393	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 ........			5,893,944	1	3,729,431
2	Savings and temporary cash investments .........			9,793	2	2,177,432
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			42,653	4	42,938
5	Loans and other receivables from 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 ......			730,833	9	732,458
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	11,032,090
b	Less: accumulated depreciation	10b	10,404,650	570,599	10c	627,440
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 ...............			10,618	14	53,802
15	Other assets. See Part IV, line 11 ...........			10,015,187	15	8,252,565
16	Total assets. Add lines 1 through 15 (must equal line 33)...			17,273,627	16	15,616,066

17	Accounts payable and accrued expenses .....	5,557,167	17	5,411,548
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	10,631,765	25	9,007,607
26	Total liabilities. Add lines 17 through 25..	16,188,932	26	14,419,155

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	91,839	27	184,912
28	Net assets with donor restrictions ...........	992,856	28	1,011,999
	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 ...........	1,084,695	32	1,196,911
33	Total liabilities and net assets/fund balances ........	17,273,627	33	15,616,066