2025-05-06T12:07:12-05:00 2024-06-16 911194016 CLARK NUBER PS 10900 NE 4TH ST STE 1400 BELLEVUE WA 98004 990 2023-07-01 911274134 OVERLAKE HOSPITAL ASSOCIATION OVER 4256885000 1035 116TH AVENUE NE BELLEVUE WA 98004 CHRISSY YAMADA INTERIM CFO 4256885000 2025-04-22 1 0 MEGAN R RYAN P00737884 4254544919 2025-04-22 2023 2025-03-06 01:10:19Z X JON DUARTE 1035 116TH AVENUE NE BELLEVUE WA 98004 11413597 0 X N/A X 1984 WA TO SUPPORT OVERLAKE MEDICAL CENTER & CLINICS AND OVERLAKE HOSPITAL FOUNDATION. X 0 0 0 17 0 0 0 0 11740837 11144098 373 947 166560 159994 11907770 11305039 7600000 8000000 0 0 0 0 0 0 0 4725218 5051910 12325218 13051910 -417448 -1746871 28473309 0 405116 0 28068193 0 X THE PURPOSE OF OVERLAKE HOSPITAL ASSOCIATION IS TO PROVIDE SUPPORT TO OVERLAKE MEDICAL CENTER & CLINICS, OVERLAKE HOSPITAL FOUNDATION THEREBY IMPROVING THE HEALTH CARE OF THE COMMUNITY. 0 1 4476491 11144098 THE ASSOCIATION RENTED 182,583 SQUARE FEET TO ITS EXEMPT AFFILIATES AND OTHER MEDICAL GROUPS DURING THE YEAR ENDED JUNE 16, 2024 ALLOWING ADDITIONAL HOSPITAL SERVICES AND PHYSICIAN SERVICES TO BE PROVIDED CLOSE TO THE HOSPITAL. 8000000 8000000 THE OVERLAKE HOSPITAL ASSOCIATION PROVIDED $8,000,000.00 OF FINANCIAL SUPPORT TO OVERLAKE MEDICAL CENTER & CLINICS FOR MODERN EQUIPMENT AND COMPREHENSIVE SERVICES AND PROGRAMS. 12476491 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 1 1 1 1 0 0 1 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X SHARON PHELPS 4256885471 1231 116TH AVE NE SUITE 600 BELLEVUE WA 98004 JASON THOMPSON CHAIR 2.00 6.00 X X 0 0 0 TOM EVERT SECRETARY & TREASURER 0.50 3.00 X X 0 0 0 PAULINE BACH TRUSTEE 1.50 3.50 X 0 0 0 KRISTINA BELFIORE TRUSTEE 0.10 1.50 X 0 0 0 ROBERT CAMPBELL TRUSTEE 3.00 3.00 X 0 0 0 JORGE CERDA TRUSTEE 1.50 1.50 X 0 0 0 ANNETTE CLARK TRUSTEE 2.00 2.00 X 0 0 0 TED HERB TRUSTEE 0.10 3.00 X 0 0 0 TIFFANY KOENIG TRUSTEE 0.10 2.00 X 0 0 0 JAMES LADD TRUSTEE 1.00 3.00 X 0 0 0 MARTHA LEE TRUSTEE 0.10 2.00 X 0 0 0 LINDA MAHAFFEY TRUSTEE 0.50 2.00 X 0 0 0 UMA RAGHAVAN-THURMAN TRUSTEE 1.00 2.00 X 0 0 0 JULIE SUN TRUSTEE 1.00 4.00 X 0 0 0 DILIP WAGLE TRUSTEE 0.10 3.00 X 0 0 0 LISA WISSNER-SLIVKA TRUSTEE 0.10 2.00 X 0 0 0 JESSIE WOOLLEY-WILSON TRUSTEE 2.00 2.00 X 0 0 0 J MICHAEL MARSH PRESIDENT & CEO 4.00 49.00 X 0 1155989 149860 ANDREW J TOKAR CFO THRU 04/24 7.00 50.00 X 0 490217 36310 PAUL ISHIZUKA INTERIM CFO FROM 03/24 0.50 49.50 X 0 0 0 0 1646206 186170 0 0 1 0 KAUFMAN HALL & ASSOCIATES LLC PO BOX 140909 IRVING TX 75014 CONSULTING 198850 UNICO PROPERTY MANAGEMENT 1326 FIFTH AVENUE SUITE 800 SEATTLE WA 98101 PROPERTY MANAGEMENT 177039 2 RENT FROM AFFILIATES 531120 11144098 11144098 11144098 947 947 268552 108558 159994 159994 159994 11305039 11144098 0 160941 8000000 8000000 133697 133697 231948 53879 178069 764637 367287 397350 121638 121638 1305134 1305134 1351393 1351393 133527 133527 REPAIRS & MAINTENANCE 996412 996412 B&O TAX 13524 13524 13051910 12476491 575419 0 1735512 0 633808 0 0 4114886 0 0 0 0 0 93610 0 0 0 21895493 0 0 0 0 0 0 28473309 0 364475 0 40641 0 405116 0 X 28068193 0 28068193 0 28473309 0 X -1746871 -26321322 X 0 1 X 1 0 X X X 2 OVERLAKE MEDICAL CENTER & CLINICS 910652651 3 1 8000000 0 OVERLAKE HOSPITAL FOUNDATION 911050325 7 1 0 0 2 8000000 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 MEDICAL CENTER & CLINICS 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 MEDICAL CENTER & CLINICS, AND OVERLAKE HOSPITAL FOUNDATION. THEREFORE, MANAGEMENT CONTROL EXISTS BETWEEN THE SUPPORTING AND SUPPORTED ORGANIZATIONS. 1 OVERLAKE MEDICAL CENTER & CLINICS 1035 116TH AVENUE NE BELLEVUE WA 98004 910652651 501(C)(3) 8000000 0 SUPPORT OPERATIONS 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 979055 0 65067 0 111867 0 130474 0 19386 0 1305849 0 102261 ANDREW J TOKAR CFO THRU 04/24 0 456772 0 30400 0 3045 0 23100 0 13210 0 526527 0 0 PART I, LINE 4B J. MICHAEL MARSH PARTICIPATES 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 2023 DEFERRALS: J. MICHAEL MARSH ($107,374) THE FOLLOWING AMOUNTS FROM THE CAPITAL ACCUMULATION ACCOUNT WERE PAID IN 2023: J. MICHAEL MARSH ($102,261). THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR FORMS 990. J. MICHAEL MARSH RECEIVED REDEMPTION OF CREDITS IN THE CAPITAL ACCUMULATION ACCOUNT THAT HAD BECOME VESTED. ANDREW TOKAR PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN BENEFIT. THIS IS A NONQUALIFIED PLAN SPONSORED BY OVERLAKE MEDICAL CENTER & CLINICS. THERE WERE NO DEFERRALS OR PLAN PAYMENTS DURING 2023. ASSET NET OF LIABILITIES ON DISSOLUTION OF ENTITY 2024-06-16 26321322 BOOK VALUE 910652651 OVERLAKE MEDICAL CENTER & CLINICS 1035 116TH AVENUE NE BELLEVUE WA 98004 501(C)(3) 0 0 0 0 1 1 1 1 0 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 III, LINE 3 OVERLAKE HOSPITAL ASSOCIATION WAS DISSOLVED AS A SEPARATE LEGAL ENTITY AND ALL REMAINING ASSETS WERE TRANSFERRED TO OVERLAKE MEDICAL CENTER & CLINICS, THE SUPPORTED ORGANIZATION OF THE ASSOCIATION. THE OVERLAKE MEDICAL TOWER, LLC BECAME A WHOLLY OWNED DISREGARDED ENTITY OF OVERLAKE MEDICAL CENTER & CLINICS AS A RESULT OF THIS MERGER. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION FILED ARTICLES OF MERGER TO OBTAIN CERTIFICATE OF MERGER FOR DISSOLUTION. FORM 990, PART VI, SECTION B, LINE 11B THE FINAL 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND WILL BE REVIEWED BY THE OVERLAKE MEDICAL CENTER & CLINICS BOARD OF DIRECTORS AS THEY REPRESENT THE INTERESTS OF OVERLAKE HOSPITAL ASSOCIATION THROUGH THE MERGER AGREEMENT. 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. BOARD MEMBERS AND MANAGEMENT ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICT OF INTEREST SITUATIONS ON THEIR ANNUAL DISCLOSURE FORM AND ON A SITUATIONAL BASIS FOR ANY SITUATION OCCURING DURING THE YEAR. DISCLOSURES ARE REVIEWED BY THE OFFICE OF COMPLIANCE AND RISK MANAGEMENT (OCRM). DISCLOSURES REQUIRING MITIGATION WILL BE HANDLED BY A MEMBER OF THE OCRM. IF THERE IS A VIOLATION OF THIS POLICY OR THERE IS A PERCEIVED OR ACTUAL CONFLICT THAT NEEDS TO BE MANAGED, THE OCRM WILL TAKE APPRORIATE CORRECTIVE ACTION, WHICH MAY INCLUDE A CONFLICT MANAGEMENT PLAN. AT BOARD MEETINGS, MEMBERS ARE EXPECTED TO RECUSE THEMSELVES FROM VOTING ON ISSUES WHEN THERE IS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE THROUGH THE HOSPITAL'S ADMINISTRATION OFFICE. THE OVERLAKE MEDICAL CENTER & CLINICS CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE ON THE ORGANIZATIONS WEBSITE. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO RELATED ORGANIZATION -26,321,322. OVERLAKE MEDICAL TOWER LLC 1135 116TH AVENUE NE BELLEVUE WA 98004 911984117 MEDICAL OFFICE SPACE RENTAL WA 10826928 0 OVERLAKE HOSPITAL ASSOCIATION OVERLAKE MEDICAL CENTER & CLINICS 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 MEDICAL CENTER & CLINICS 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 OVERLAKE MEDICAL CENTER & CLINICS A 7240704 FAIR MARKET VALUE OVERLAKE MEDICAL CENTER & CLINICS B 8000000 CASH OVERLAKE MEDICAL CENTER & CLINICS O 158357 CASH OVERLAKE MEDICAL CENTER & CLINICS P 379597 CASH OVERLAKE MEDICAL CENTER & CLINICS R 26321322 CASH SCHEDULE R, PART V, LINE 1O: SALARIES ARE PAID BY OVERLAKE MEDICAL CENTER & CLINICS 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, ANDREW TOKAR, AND PAUL ISHIZUKA BASED ON HOURS REPORTED SPENT ON OVERLAKE HOSPITAL ASSOCIATION.