2024-05-10T13:32:31-05:00 2023-06-30 911194016 CLARK NUBER PS 10900 NE 4TH ST STE 1400 BELLEVUE WA 98004 990 2022-07-01 911274134 OVERLAKE HOSPITAL ASSOCIATION OVER 4256885000 1035 116TH AVENUE NE BELLEVUE WA 98004 PAUL ISHIZUKA INTERIM CFO 4256885000 2024-05-04 1 PAUL ISHIZUKA 999009999 0 MEGAN R RYAN P00737884 4254544919 2024-05-04 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z J MICHAEL MARSH 1035 116TH AVENUE NE BELLEVUE WA 98004 12014746 0 X N/A X 1984 WA TO SUPPORT OVERLAKE HOSPITAL MEDICAL CENTER AND OVERLAKE HOSPITAL FOUNDATION. 17 17 0 17 0 0 0 0 11237448 11740837 195 373 146772 166560 11384415 11907770 4500000 7600000 0 0 0 0 0 0 0 4741618 4725218 9241618 12325218 2142797 -417448 29520780 28473309 1035139 405116 28485641 28068193 THE PURPOSE OF OVERLAKE HOSPITAL ASSOCIATION IS TO PROVIDE SUPPORT TO OVERLAKE HOSPITAL MEDICAL CENTER, OVERLAKE HOSPITAL FOUNDATION THEREBY IMPROVING THE HEALTH CARE OF THE COMMUNITY. 0 0 4586291 11740837 THE ASSOCIATION RENTED 178,523 SQUARE FEET TO ITS EXEMPT AFFILIATES AND OTHER MEDICAL GROUPS AS OF JUNE 30, 2023 ALLOWING ADDITIONAL HOSPITAL SERVICES AND PHYSICIAN SERVICES TO BE PROVIDED CLOSE TO THE HOSPITAL. 7600000 7600000 THE OVERLAKE HOSPITAL ASSOCIATION PROVIDED $7,600,000.00 OF FINANCIAL SUPPORT TO OVERLAKE HOSPITAL MEDICAL CENTER FOR MODERN EQUIPMENT AND COMPREHENSIVE SERVICES AND PROGRAMS. 12186291 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X LINDSEY SOBOLOSKI 4256885149 1231 116TH AVE NE SUITE 600 BELLEVUE WA 98004 JASON THOMPSON CHAIR 0.50 6.00 X X 0 0 0 TOM EVERT SECRETARY & TREASURER 0.50 2.00 X X 0 0 0 ROBERT CAMPBELL TRUSTEE 4.00 4.00 X 0 0 0 PAULINE BACH TRUSTEE 1.00 3.50 X 0 0 0 KIRSTINA BELFIORE TRUSTEE 0.50 2.00 X 0 0 0 JORGE CERDA TRUSTEE 3.00 3.00 X 0 0 0 ANNETTE CLARK TRUSTEE 2.00 2.00 X 0 0 0 TED HERB TRUSTEE 2.00 2.00 X 0 0 0 TIFFANY KOENIG TRUSTEE 0.50 1.50 X 0 0 0 JAMES LADD TRUSTEE 0.50 3.00 X 0 0 0 MARTHA LEE TRUSTEE 3.00 3.00 X 0 0 0 LINDA MAHAFFEY TRUSTEE 1.00 1.50 X 0 0 0 UMA RAGHAVAN TRUSTEE 0.50 4.00 X 0 0 0 JULIE SUN FOUNDATION REPRESENTATIVE 2.00 5.00 X 0 0 0 DILIP WAGLE TRUSTEE 1.00 2.00 X 0 0 0 LISA WISSNER-SLIVKA TRUSTEE 1.00 5.00 X 0 0 0 JESSIE WOOLLEY-WILSON TRUSTEE 2.00 2.00 X 0 0 0 J MICHAEL MARSH PRESIDENT & CEO 4.00 55.00 X 0 1462825 144346 ANDREW J TOKAR CHIEF FINANCIAL OFFICER 5.00 52.00 X 0 591433 72826 0 2054258 217172 0 0 1 0 UNICO PROPERTY MANAGEMENT 1326 FIFTH AVENUE SUITE 800 SEATTLE WA 98101 PROPERTY MANAGER 235252 1 RENT FROM AFFILIATES 531120 11740837 11740837 11740837 373 373 273536 106976 166560 166560 166560 11907770 11740837 0 166933 X 7600000 7600000 167709 167709 22876 22200 676 1258756 1146865 111891 129526 129526 1505212 1505212 1427279 1427279 REPAIRS & MAINTENANCE 184278 157918 26360 B&O TAX 27666 27666 ASBESTOS ACCRETION 1916 1916 12325218 12186291 138927 0 1092674 1735512 633435 633808 4334812 4114886 101666 93610 62533327 40637834 23358193 21895493 29520780 28473309 253520 364475 742702 0 38917 40641 1035139 405116 X 28485641 28068193 28485641 28068193 29520780 28473309 -417448 0 X 0 1 X 1 0 X X X 2 OVERLAKE HOSPITAL MEDICAL CENTER 910652651 3 1 7600000 0 OVERLAKE HOSPITAL FOUNDATION 911050325 7 1 0 0 2 7600000 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION C, LINE 1: THE BOARD OF DIRECTORS OF OVERLAKE HOSPITAL ASSOCIATION AND THE BOARD OF TRUSTEES OF OVERLAKE HOSPITAL MEDICAL CENTER ARE COMPRISED OF THE SAME MEMBERS. WHILE THE MAJORITY OF OVERLAKE HOSPITAL ASSOCIATION'S BOARD ARE NOT BOARD MEMBERS OF OVERLAKE HOSPITAL FOUNDATION, THE SAME INDIVIDUALS ARE PRESIDENT & CEO AND CFO OF OVERLAKE HOSPITAL ASSOCIATION, OVERLAKE HOSPITAL MEDICAL CENTER, AND OVERLAKE HOSPITAL FOUNDATION. THEREFORE, MANAGEMENT CONTROL EXISTS BETWEEN THE SUPPORTING AND SUPPORTED ORGANIZATIONS. 4545404 4545404 53935823 36629467 17306356 116004 116004 0 3936096 3892363 43733 21895493 ASBESTOS REMEDIATION LIABILITY 40641 40641 1 OVERLAKE HOSPITAL MEDICAL CENTER 1035 116TH AVENUE NE BELLEVUE WA 98004 910652651 501(C)(3) 7600000 0 GENERAL SUPPORT 1 0 PART I, LINE 2: OVERLAKE HOSPITAL ASSOCIATION DOES NOT GIVE GRANTS OR RECEIVES GRANTS. THE GRANT IS A TRANSFER BETWEEN RELATED ENTITIES UNDER COMMON CONTROL. THE ACCOUNTING FOR BOTH ENTITIES ARE PERFORMED BY THE SAME STAFF AND THERE IS NO ONGOING MONITORING OF THE TRANSFER. 0 1 0 0 0 0 0 0 0 J MICHAEL MARSH PRESIDENT & CEO 0 926784 0 429961 0 106080 0 123611 0 20735 0 1607171 0 96473 ANDREW J TOKAR CHIEF FINANCIAL OFFICER 0 443482 0 144978 0 2973 0 60094 0 12732 0 664259 0 0 PART I, LINE 4B J. MICHAEL MARSH AND ANDREW J. TOKAR PARTICIPATE IN A BENEFIT WITHIN THE EXECUTIVE BENEFIT PLAN CALLED THE CAPITAL ACCUMULATION ACCOUNT. THE CAPITAL ACCUMULATION ACCOUNT IS CLASSIFIED AS A 457(F) PLAN BY THE IRS. THE FOLLOWING AMOUNTS REFLECT 2022 DEFERRALS: J. MICHAEL MARSH ($102,261) AND ANDREW J. TOKAR ($38,744) THE FOLLOWING AMOUNTS FROM THE CAPITAL ACCUMULATION ACCOUNT WERE PAID IN 2022: J. MICHAEL MARSH ($96,473). FORM 990, PART 1, LINE 6: OVERLAKE HOSPITAL ASSOCIATION HAD 17 BOARD MEMBERS THAT VOLUNTEERED THEIR TIME AS BOARD MEMBERS DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THE REVIEWED BY THE PRESIDENT AND CEO, CFO, OVERLAKE HOSPITAL MEDICAL CENTER CHIEF COMPLIANCE OFFICER AND OVERLAKE HOSPITAL MEDICAL CENTER AUDIT AND COMPLIANCE COMMITTEE. THE 990 IS SENT TO THE OVERLAKE HOSPITAL ASSOCIATION BOARD MEMBERS PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND MANAGEMENT ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, 2) HAS READ AND UNDERSTANDS THE POLICY, 3) HAS AGREED TO COMPLY WITH THE POLICY, AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN THEIR FEDERAL TAX EXEMPTION THEY MUST AVOID CONFLICTS OF INTEREST AND ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF THEIR TAX-EXEMPT FUNCTIONS. A LIST OF ALL FINANCIALS INTERESTS OF OTHER RELATIONSHIPS WITH ANY ORGANIZATION THAT HAS, OR CAN BE REASONABLY EXPECTED TO HAVE, A TRANSACTION WITH THE CORPORATION, COMPETES AGAINST THE CORPORATION, OR WHOSE INTEREST MATERIALLY CONFLICTS WITH THE INTEREST OF THE CORPORATION IS SUBMITTED ANNUALLY TO THE OVERLAKE HOSPITAL MEDICAL CENTER COMPLIANCE OFFICER REVIEW. THE COMPLIANCE OFFICER SUMMARIZES ANY CONFLICTS OF INTEREST AND DISCUSSES THESE RESULTS WITH THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE, CEO, AND GENERAL COUNSEL. THIS INFORMATION IS ALSO SHARED WITH THE BOARD CHAIR, COMMITTEE CHAIRS, AND THE CFO. AT BOARD MEETINGS, MEMBERS ARE EXPECTED TO RESCUSE THEMSELVES FROM VOTING ON ISSUES WHEN THERE IS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 OVERLAKE HOSPITAL ASSOCIATION MAKES ITS GOVERNING CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE THORUGH THE HOSPITAL'S ADMINISTRATION OFFICE. THE OVERLAKE HOSPITAL ASSOCIATION CONSOLIDATED FINANCIALS STATEMENTS ARE ALSO AVAILABLE ON THE OVERLAKE MEDICAL CENTER'S WEBSITE. FORM 990, PART IX, LINE 11G ADMINISTRATIVE: PROGRAM SERVICE EXPENSES 867,001. MANAGEMENT AND GENERAL EXPENSES 7,184. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 874,185. JANITORIAL: PROGRAM SERVICE EXPENSES 279,864. MANAGEMENT AND GENERAL EXPENSES 104,707. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 384,571. OVERLAKE MEDICAL TOWER LLC 1135 116TH AVENUE NE BELLEVUE WA 98004 911984117 MEDICAL OFFICE SPACE RENTAL WA 11007909 22892341 OVERLAKE HOSPITAL ASSOCIATION OVERLAKE HOSPITAL MEDICAL CENTER 1035 116TH AVENUE NE BELLEVUE WA 98004 910652651 HOSPITAL WA 501(C)(3) LINE 3 OVERLAKE HOSPITAL ASSOCIATION 1 OVERLAKE HOSPITAL FOUNDATION 1035 116TH AVENUE NE BELLEVUE WA 98004 911050325 FUNDRAISING WA 501(C)(3) LINE 7 OVERLAKE HOSPITAL MEDICAL CENTER 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 OVERLAKE HOSPITAL MEDICAL CENTER A 8565441 FAIR MARKET VALUE OVERLAKE HOSPITAL MEDICAL CENTER B 7600000 CASH OVERLAKE HOSPITAL MEDICAL CENTER O 173782 CASH OVERLAKE HOSPITAL MEDICAL CENTER P 580373 CASH SCHEDULE R, PART V, LINE 1O: SALARIES ARE PAID BY OVERLAKE HOSPITAL MEDICAL CENTER AND ARE NOT ALLOCATED TO OVERLAKE HOSPITAL ASSOCIATION ON PART IX. THE SALARIES REPORTED ON LINE 1O REPRESENT AN ALLOCATION OF SALARIES AND BENEFITS FOR J. MICHAEL MARSH AND ANDREW TOKAR BASED ON HOURS REPORTED SPENT ON OVERLAKE HOSPITAL ASSOCIATION.