TY 2021 Form 990 Schedule O

Instrumentl eFile RenderObject ID: 202223019349301982 - Rendered 2024-10-24 TIN: 20-0413676

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.
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Attach to Form 990 or 990-EZ.
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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

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	UPON COMPLETION OF THE INTERNAL REVIEWS, THE FOUNDATION'S FINANCE DEPARTMENT PROVIDES EACH BOARD MEMBER A COPY FOR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. ONCE THE BOARD HAS REVIEWED AND APPROVED THE FILING, THE BOARD CHAIR AUTHORIZES THE FEDERAL FORM 990 TO BE E-FILED.
FORM 990, PART VI, SECTION B, LINE 12C	THE FOUNDATION'S PRESIDENT AND THE BOARD COMPLIANCE OFFICER WORK TOGETHER TO ENSURE ADHERENCE TO THE FOUNDATION'S COMPLIANCE PROGRAM. INCLUDED IN THIS COMPLIANCE PROGRAM ARE THE FOLLOWING ELEMENTS: STAFF AND BOARD OF DIRECTORS ARE REQUIRED TO FOLLOW A CODE OF CONDUCT; STAFF MUST SIGN A CONFIDENTIALITY AND CONFLICT OF INTEREST AGREEMENT UPON HIRE; MEMBERS OF THE BOARD OF DIRECTORS AND SENIOR STAFF ARE PROVIDED A COMPLIANCE MANUAL AND MUST SIGN A CONFLICT OF INTEREST DISCLOSURE ANNUALLY (BOARD MEMBERS THAT ARE DEEMED TO HAVE A CONFLICT OF INTEREST BASED ON THIS DISCLOSURE ARE RECUSED FROM PARTICIPATING IN A VOTE WITHIN THAT AREA OF CONFLICT); AND SENIOR STAFF AND BOARD ALSO ATTEST TO UNDERSTANDING AND ADHERING TO THE POLICIES AND PRACTICES OF THE HEALTHWELL FOUNDATION. THE SENIOR STAFF AND BOARD CANNOT REFER PATIENTS TO APPLY FOR ASSISTANCE FROM THE FOUNDATION, OR RECOMMEND A PARTICULAR PROVIDER, SUPPLIER, OR PRODUCT FOR AN APPLICANT OR PATIENT, OR DISCLOSE THE IDENTITY ANY PROGRAM DONOR. THE COMPLIANCE OFFICER PROVIDES ANNUAL COMPLIANCE TRAINING TO ALL STAFF.
FORM 990, PART VI, SECTION B, LINE 15	HEALTHWELL BOARD OF DIRECTORS CONDUCTED A COMPENSATION REVIEW IN 2021 FOR THE PRESIDENT. THE BOARD ENGAGED AN INDEPENDENT CONSULTANT, MARSH MCLENNAN, TO CONDUCT THE ANALYSIS. THE BOARD CHAIR, TREASURER, AND A BOARD DIRECTOR REVIEWED AND APPROVED THE PRESIDENT'S COMPENSATION. HEALTHWELL WILL ENGAGE MARSH MCLENNAN TO CONDUCT A COMPENSATION REVIEW FOR ALL POSITIONS AT HEALTHWELL BASED ON UPDATED JOB DESCRIPTIONS IN 2022 (THE LAST PRIOR ONE WAS UNDERTAKEN IN 2018). THE BOARD CHAIR, TREASURER, A BOARD DIRECTOR, AND THE PRESIDENT WILL REVIEW AND APPROVE ALL COMPENSATION FOR THE REMAINING FOUNDATION STAFF.
FORM 990, PART VI, SECTION C, LINE 19	THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND THE FEDERAL FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FEDERAL FORM 990, THE FOUNDATION'S FINANCIALS, AND ANNUAL REPORT ARE ALSO AVAILABLE AT WWW.HEALTHWELLFOUNDATION.ORG.
FORM 990, PART XII, LINE 2C:	THERE WERE NO CHANGES FROM THE PRIOR YEAR.

Return Reference

Explanation

FORM 990, PART VI, SECTION B, LINE 11B

UPON COMPLETION OF THE INTERNAL REVIEWS, THE FOUNDATION'S FINANCE DEPARTMENT PROVIDES EACH BOARD MEMBER A COPY FOR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. ONCE THE BOARD HAS REVIEWED AND APPROVED THE FILING, THE BOARD CHAIR AUTHORIZES THE FEDERAL FORM 990 TO BE E-FILED.

FORM 990, PART VI, SECTION B, LINE 12C

THE FOUNDATION'S PRESIDENT AND THE BOARD COMPLIANCE OFFICER WORK TOGETHER TO ENSURE ADHERENCE TO THE FOUNDATION'S COMPLIANCE PROGRAM. INCLUDED IN THIS COMPLIANCE PROGRAM ARE THE FOLLOWING ELEMENTS: STAFF AND BOARD OF DIRECTORS ARE REQUIRED TO FOLLOW A CODE OF CONDUCT; STAFF MUST SIGN A CONFIDENTIALITY AND CONFLICT OF INTEREST AGREEMENT UPON HIRE; MEMBERS OF THE BOARD OF DIRECTORS AND SENIOR STAFF ARE PROVIDED A COMPLIANCE MANUAL AND MUST SIGN A CONFLICT OF INTEREST DISCLOSURE ANNUALLY (BOARD MEMBERS THAT ARE DEEMED TO HAVE A CONFLICT OF INTEREST BASED ON THIS DISCLOSURE ARE RECUSED FROM PARTICIPATING IN A VOTE WITHIN THAT AREA OF CONFLICT); AND SENIOR STAFF AND BOARD ALSO ATTEST TO UNDERSTANDING AND ADHERING TO THE POLICIES AND PRACTICES OF THE HEALTHWELL FOUNDATION. THE SENIOR STAFF AND BOARD CANNOT REFER PATIENTS TO APPLY FOR ASSISTANCE FROM THE FOUNDATION, OR RECOMMEND A PARTICULAR PROVIDER, SUPPLIER, OR PRODUCT FOR AN APPLICANT OR PATIENT, OR DISCLOSE THE IDENTITY ANY PROGRAM DONOR. THE COMPLIANCE OFFICER PROVIDES ANNUAL COMPLIANCE TRAINING TO ALL STAFF.

FORM 990, PART VI, SECTION B, LINE 15

HEALTHWELL BOARD OF DIRECTORS CONDUCTED A COMPENSATION REVIEW IN 2021 FOR THE PRESIDENT. THE BOARD ENGAGED AN INDEPENDENT CONSULTANT, MARSH MCLENNAN, TO CONDUCT THE ANALYSIS. THE BOARD CHAIR, TREASURER, AND A BOARD DIRECTOR REVIEWED AND APPROVED THE PRESIDENT'S COMPENSATION. HEALTHWELL WILL ENGAGE MARSH MCLENNAN TO CONDUCT A COMPENSATION REVIEW FOR ALL POSITIONS AT HEALTHWELL BASED ON UPDATED JOB DESCRIPTIONS IN 2022 (THE LAST PRIOR ONE WAS UNDERTAKEN IN 2018). THE BOARD CHAIR, TREASURER, A BOARD DIRECTOR, AND THE PRESIDENT WILL REVIEW AND APPROVE ALL COMPENSATION FOR THE REMAINING FOUNDATION STAFF.

FORM 990, PART VI, SECTION C, LINE 19

THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND THE FEDERAL FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FEDERAL FORM 990, THE FOUNDATION'S FINANCIALS, AND ANNUAL REPORT ARE ALSO AVAILABLE AT WWW.HEALTHWELLFOUNDATION.ORG.

FORM 990, PART XII, LINE 2C:

THERE WERE NO CHANGES FROM THE PRIOR YEAR.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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