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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
HEALTHWELL FOUNDATION
 
Employer identification number
20-0413676
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

Schedule I (Form 990) 2021
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) MULTIPLE MYELOMA - MEDICARE ACCESS 28364 168,135,449      
(2) PROSTATE CANCER - MEDICARE ACCESS 12116 44,379,122      
(3) PULMONARY FIBROSIS 9237 43,948,488      
(4) MULTIPLE SCLEROSIS - MEDICARE ACCESS 9580 43,006,616      
(5) HYPERCHOLESTEROLEMIA - MEDICARE ACCESS 36786 39,732,005      
(6) HEPATITIS C 5896 36,563,752      
(7) PULMONARY HYPERTENSION - MEDICARE ACCESS 7078 36,147,726      
(8) RENAL CELL CARCINOMA - MEDICARE ACCESS 6367 34,731,653      
(9) CHRONIC LYMPHOCYTIC LEUKEMIA 5753 22,357,875      
(10) TARDIVE DYSKINESIA - MEDICARE ACCESS 4530 19,642,593      
(11) ACUTE MYELOID LEUKEMIA 5511 19,079,067      
(12) POST MENOPAUSAL OSTEOPOROSIS - MEDICARE ACCESS 32601 16,564,927      
(13) CYSTIC FIBROSIS TREATMENTS 7825 15,274,243      
(14) BREAST CANCER - MEDICARE ACCESS 3063 14,336,306      
(15) MYELODYSPLASTIC SYNDROMES - MEDICARE ACCESS 2795 9,668,607      
(16) MANTLE CELL LYMPHOMA 1461 6,183,039      
(17) CYSTIC FIBROSIS VITAMINS AND SUPPLEMENTS 7470 5,279,724      
(18) SYSTEMIC LUPUS ERYTHEMATOSUS 1377 4,260,272      
(19) PEYRONIE'S DISEASE 1592 3,985,951      
(20) DUPUYTREN'S DISEASE 2183 3,380,137      
(21) AMYOTROPHIC LATERAL SCLEROSIS 897 3,245,743      
(22) AMYLOIDOSIS 552 3,165,815      
(23) SMALL CELL LUNG CANCER - MEDICARE ACCESS 1039 3,156,367      
(24) COLORECTAL CARCINOMA - MEDICARE ACCESS 1053 2,749,419      
(25) NON-SMALL CELL LUNG CANCER - MEDICARE ACCESS 864 2,533,376      
(26) CONGENITAL SUCRASE-ISOMALTASE DEFICIENCY 613 2,437,036      
(27) BONE METASTASES - MEDICARE ACCESS 1618 2,399,475      
(28) MELANOMA - MEDICARE ACCESS 442 2,309,016      
(29) GOUT - MEDICARE ACCESS 1223 2,145,568      
(30) OVARIAN CANCER - MEDICARE ACCESS 892 2,051,630      
(31) MACULAR DEGENERATION (WET AND DRY) 1099 1,374,621      
(32) SECONDARY HYPERPARATHYROIDISM 1241 813,748      
(33) HEAD AND NECK CANCER - MEDICARE ACCESS 379 787,226      
(34) URTICARIA 412 773,673      
(35) LAMBERT-EATON MYASTHENIC SYNDROME 115 765,142      
(36) SICKLE CELL DISEASE 196 568,416      
(37) CHRONIC MYELOID LEUKEMIA - MEDICARE ACCESS 99 424,143      
(38) CHEMOTHERAPY INDUCED NEUTROPENIA - MEDICARE ACCESS 267 400,561      
(39) ASTHMA 205 400,497      
(40) GIANT CELL ARTERITIS OR TEMPORAL ARTERITIS - MEDICARE ACCESS 143 381,414      
(41) PANCREATIC CANCER - MEDICARE ACCESS 152 320,780      
(42) NEUROCOGNITIVE DISEASE WITH PSYCHOSIS - MEDICARE ACCESS 225 286,344      
(43) ANCA-ASSOC VASCULITIS, AND GRANULOMATOSIS WITH POLYANGIITIS (FORMERLY WEGENERS) 80 206,112      
(44) ADRENAL INSUFFICIENCY 79 192,514      
(45) ACROMEGALY 64 185,547      
(46) MOVEMENT DISORDERS - MEDICARE ACCESS 70 127,983      
(47) CANCER-RELATED BEHAVIORAL HEALTH 89 109,244      
(48) CYTOMEGALOVIRUS DISEASE - PREVENTION AND TREATMENT 125 102,871      
(49) NONTUBERCULOUS MYCOBACTERIUM - MEDICARE ACCESS 95 81,529      
(50) HOMOCYSTINURIA 46 77,350      
(51) COVID-19 FRONTLINE HEALTH CARE WORKERS BEHAVIORAL HEALTH 64 69,588      
(52) CHRONIC HEART FAILURE - MEDICARE ACCESS 54 63,774      
(53) BLADDER AND UROTHELIAL CANCER - MEDICARE ACCESS 31 55,824      
(54) CUSHING'S DISEASE 12 47,343      
(55) B-CELL LYMPHOMA - MEDICARE ACCESS 10 40,921      
(56) PORPHYRIAS 11 32,991      
(57) COVID-19 ANCILLARY COSTS 184 25,000      
(58) GOUT TRAVEL FUND 14 19,500      
(59) HYPEROXALURIA 14 16,350      
(60) MIGRAINE 45 14,895      
(61) PEDIATRIC ASSISTANCE 1128 12,125      
(62) UREA CYCLE DISORDERS 2 6,370      
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: EACH PATIENT SEEKING ASSISTANCE IS SCREENED FOR ELIGIBILITY EITHER BY A SPECIALIST THROUGH THE FOUNDATION HOTLINE OR THROUGH THE FOUNDATION'S ONLINE APPLICATION TOOL. CRITERIA ARE STATIC ACROSS ALL OF THE FOUNDATION FUNDS: DEPENDING ON THE PARTICULAR FUND FROM WHICH THE GRANT ISSUES, THE PATIENT'S HOUSEHOLD INCOME MAY BE UP TO 500% OF THE FEDERAL POVERTY LEVEL, ADJUSTED FOR HOUSEHOLD SIZE AND HIGH COST OF LIVING AREAS; THE PATIENT MUST HAVE A DIAGNOSIS THAT THE FOUNDATION CURRENTLY SUPPORTS; THE PATIENT MUST HAVE INSURANCE COVERAGE FOR THE TREATMENT FOR WHICH THEY ARE SEEKING ASSISTANCE; THAT TREATMENT MUST BE AN ELIGIBLE TREATMENT UNDER THE HEALTHWELL FUND; AND THE TREATMENT MUST BE DISPENSED IN THE UNITED STATES. IN ADDITION, DURING THE APPROVAL PROCESS, A SOFT CREDIT CHECK IS RUN ON THE APPLICANT TO DETERMINE THAT THEY MEET THE INCOME REQUIREMENTS FOR THE PROGRAM. IF THE SOFT CREDIT CHECK DOES NOT RETURN A SATISFACTORY RESULT, THE PATIENT IS REQUIRED TO SUBMIT A FULL INCOME DOCUMENT REVIEW IN ORDER TO RECEIVE ASSISTANCE THROUGH THE PROGRAM. OTHERWISE, PATIENTS ARE APPROVED IF ALL CRITERIA ARE MET DURING SCREENING. PATIENTS RECEIVE A PHARMACY CARD TO USE AT THE LOCAL RETAIL PHARMACY, THROUGH MAIL ORDER PHARMACY, OR THROUGH SPECIALTY PHARMACY. THE PHARMACY CARD CANNOT BE USED FOR PRIMARY PAYMENT AND PROVIDES ELECTRONIC POINT OF SALE REIMBURSEMENT FOR THE PHARMACY. IN CASES WHERE THE PHARMACY CARD CANNOT BE USED, THE FOUNDATION REQUIRES THE SUBMISSION OF A COMPLETED REIMBURSEMENT REQUEST FORM ALONG WITH ADDITIONAL INFORMATION AS OUTLINED ON THE FORM. UPON RECEIPT, THE REQUEST IS REVIEWED: A FOUNDATION PAYMENT SPECIALIST ENTERS THE RECEIVED INFORMATION INTO THE SYSTEM AND THE SYSTEM VALIDATES THE DATE OF SERVICE, AN INSURER PAID FIRST, THE PRODUCT IS AN ELIGIBLE TREATMENT UNDER THE HEALTHWELL FUND, AND THE PATIENT HAS AN ACTIVE, FULLY APPROVED GRANT. ONLY IF ALL SYSTEMATIC CHECKS PASS, THE PAYMENT SPECIALIST PROCESSES THE PAYMENT.
Schedule I (Form 990) 2021



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