2021-05-12T12:09:23-05:00 2020-06-30 911194016 CLARK NUBER PS 10900 NE 4TH ST STE 1400 BELLEVUE WA 98004 990 2019-07-01 911050325 OVERLAKE HOSPITAL FOUNDATION OVER 4256885000 1035 116TH AVENUE NE BELLEVUE WA 98004 ANDREW TOKAR CFO 4256885000 2021-05-06 1 SARA ELIZABETH J HYRE P00235495 4254544919 2021-05-06 2019 2022-09-23 18:48:47Z MARY BETH STEARNS 1035 116TH AVENUE NE BELLEVUE WA 98004 12573638 0 X WWW.OVERLAKEHOSPITAL.ORG/WAYS-TO-GIVE X 1978 WA THE PURPOSE OF OVERLAKE HOSPITAL FOUNDATION IS TO ADVANCE AND IMPROVE MEDICAL AND HEALTH CARE EXCELLENCE BY PROVIDING FUNDRAISING AND OTHER SUPPORT TO OVERLAKE HOSPITAL MEDICAL CENTER FOR NEW FACILITIES, MODERN EQUIPMENT AND COMPREHENSIVE SERVICES AND PROGRAMS. 19 19 12 29 0 0 12485092 9499440 0 0 646597 685960 -209640 0 12922049 10185400 7740090 8967335 0 0 1237998 1341212 0 0 1192915 440490 660854 9418578 10969401 3503471 -784001 25329256 24564686 169553 561199 25159703 24003487 THE PURPOSE OF OVERLAKE HOSPITAL FOUNDATION IS TO ADVANCE AND IMPROVE MEDICAL AND HEALTH CARE EXCELLENCE BY PROVIDING FUNDRAISING AND OTHER SUPPORT TO OVERLAKE HOSPITAL MEDICAL CENTER FOR NEW FACILITIES, MODERN EQUIPMENT AND COMPREHENSIVE SERVICES AND PROGRAMS. 0 0 8967335 8967335 OVERLAKE HOSPITAL FOUNDATION RAISED $7,557,440 IN CONTRIBUTIONS AND PLEDGES FROM DONORS. THE FOUNDATION PROVIDED $8,967,335 OF FINANCIAL SUPPORT TO OVERLAKE HOSPITAL MEDICAL CENTER FOR NEW FACILITIES, MODERN EQUIPMENT AND COMPREHENSIVE SERVICES AND PROGRAMS. THE DIFFERENCE BETWEEN CONTRIBUTION REVENUE AND THE SUPPORT PROVIDED TO OVERLAKE HOSPITAL IS DUE TO THE TIMING OF PLEDGE PAYMENTS. 8967335 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 12 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 19 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 WA X LINDSEY SOBOLOSKI 4256885552 1035 116TH AVENUE NE BELLEVUE WA 98004 X J MICHAEL MARSH PRESIDENT & CEO 10.00 50.00 X 0 1701661 130722 MARY BETH STEARNS CHIEF DEVELOPMENT OFFICER 49.00 1.00 X 690649 0 70681 ANDREW TOKAR CFO 1.00 56.00 X 0 492695 74836 STEPHANIE STEWART DEPARTMENT DIRECTOR 40.00 0.00 X 173392 0 26720 JEFF WILCOX CHAIR 0.50 0.00 X X 0 0 0 PAULINE BACH SECRETARY 0.75 0.00 X X 0 0 0 JULIE SUN TREASURER 1.00 0.00 X X 0 0 0 TIFFANY KOENIG IMMEDIATE PAST CHAIR 1.00 1.00 X X 0 0 0 LYNNETTE ANDERSON AUXILIARIES REPRESENTATIVE 0.50 0.30 X 0 0 0 MERRILL BEHNKE TRUSTEE 1.50 0.00 X 0 0 0 RACHELE BOUCHAND TRUSTEE 1.00 0.00 X 0 0 0 HALEH CLAPP TRUSTEE 1.00 0.00 X 0 0 0 PATTY EDWARDS TRUSTEE 1.50 0.00 X 0 0 0 JAMES GREGSON TRUSTEE 1.00 0.00 X 0 0 0 YORK HARRIS TRUSTEE 0.75 0.00 X 0 0 0 BENJAMIN LIU TRUSTEE 1.00 0.00 X 0 0 0 WARREN MICHELSEN TRUSTEE 0.50 0.00 X 0 0 0 TAYLOR MILLER TRUSTEE 1.00 0.00 X 0 0 0 LANI MOBIUS TRUSTEE 1.00 0.00 X 0 0 0 STEVE NICHOLES TRUSTEE 2.00 0.00 X 0 0 0 TARA REIMERS MD TRUSTEE 2.00 0.00 X 0 0 0 MICHAEL RIDGEWAY TRUSTEE 1.50 0.00 X 0 0 0 STACY SPELMAN TRUSTEE 1.00 0.00 X 0 0 0 CLAIRE SUMADIRWIRYA TRUSTEE 1.25 0.00 X 0 0 0 TYLER TONKIN TRUSTEE 0.50 0.00 X 0 0 0 864041 2194356 302959 2 0 1 0 0 1938431 7561009 2220077 9499440 600693 600693 2473505 2388238 85267 85267 85267 10185400 0 0 685960 X 8967335 8967335 475084 190034 285050 693689 286913 406776 98347 40677 57670 74092 30645 43447 56695 56695 356672 52775 303897 5075 5075 105001 19357 85644 4103 4103 101071 101071 8886 8384 502 1994 1994 12209 12209 FOOD 5652 798 4854 MEMBERSHIP DUES 3496 3496 10969401 8967335 809151 1192915 2624825 1000639 39430 351254 8833496 9276770 31098 72798 341506 341506 0 0 13791998 13521292 8409 341933 25329256 24564686 140257 124872 29296 35331 0 400996 169553 561199 X 6066156 4295669 19093547 19707818 25159703 24003487 25329256 24564686 X -784001 -368646 -3569 X 0 1 X 1 0 X 5469829 12973462 7967289 12481273 9499440 48391293 5469829 12973462 7967289 12481273 9499440 48391293 8910729 39480564 376417 388459 526114 642294 600693 2533977 50925270 0.77530 0.72230 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 13480020 270372 316445 325186 13741651 13003120 110825 739360 373285 13480020 12076705 514507 907218 495310 13003120 10965973 163571 1354368 407207 12076705 11134453 103582 126822 398884 10965973 0.31000 0.44000 0.25000 0 0 154803 154803 0 186703 186703 0 0 CAPITAL LEASE OBLIGATION 400996 400996 9756490 -368646 -368646 10125136 56695 3569 60264 10185400 10912706 0 10912706 56695 56695 10969401 PART IV, LINE 2B: ANNUITIES ARE HELD IN A CUSTODIAL ACCOUNT (BNY MELLON). THE ASSETS AND LIABLILITY ARE REPORTED ON THE BALANCE SHEET. PART V, LINE 4: ENDOWMENT DISTRIBUTIONS ARE USED TO SUPPORT CAPITAL AND OPERATIONAL NEEDS OF OVERLAKE HOSPITAL MEDICAL CENTER AS DIRECTED BY THE INDIVIDUAL ENDOWMENT PURPOSE. PART XI, LINE 4B - OTHER ADJUSTMENTS: PRIOR YEAR PLEDGE WRITE-OFF 3,569. 1 OVERLAKE HOSPITAL MEDICAL CENTER 1035 116TH AVENUE NE BELLEVUE WA 98004 910652651 501(C)(3) 8967335 SUPPORT OVERLAKE HOSPITAL 1 0 PART I, LINE 2: OVERLAKE HOSPITAL FOUNDATION STAFF NOTIFIES THE OVERLAKE HOSPITAL MEDICAL CENTER ACCOUNTING STAFF WHEN THERE IS A SPECIFIC GRANT. IF THE GRANT IS FOR OPERATIONAL EXPENSES THAT THE HOSPITAL DOES NOT INCUR IN THE NORMAL COURSE OF BUSINESS, THE APPROPRIATE DEPARTMENT IN THE HOSPITAL IS CONTACTED TO DEVELOP PLANS AND TIMING FOR USING THE FUNDS AS DESIGNATED. IF THE GRANT IS FOR CAPITAL, THE ACCOUNTING STAFF WILL MONITOR WHEN THE CAPITAL HAS BEEN PURCHASED AND RELEASE THE GRANT FROM RESTRICTION. WHEN THE DEPARTMENT MAKES THE EXPENDITURE, ACCOUNTING IS NOTIFIED, AND THE RESTRICTION OF THE GRANT IS RELEASED. X X X X X 0 1 0 0 0 0 0 0 0 J MICHAEL MARSH PRESIDENT & CEO 0 791430 0 282526 0 627705 0 113274 0 17448 0 1832383 0 605451 MARY BETH STEARNS CHIEF DEVELOPMENT OFFICER 257027 0 72287 0 361335 0 58112 0 12569 0 761330 0 0 0 ANDREW TOKAR CFO 0 381262 0 68570 0 42863 0 67043 0 7793 0 567531 0 0 STEPHANIE STEWART DEPARTMENT DIRECTOR 160752 0 12321 0 319 0 14195 0 12525 0 200112 0 0 0 PART I, LINE 4B J. MICHAEL MARSH AND MARY BETH STEARNS PARTICIPATED 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. NO PAYMENTS WERE SENT TO J. MICHAEL MARSH OR MARY BETH STEARNS IN 2019. X 21 2220077 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN PART I COLUMN (B) IS BASED ON THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART I, LINE 6: OVERLAKE HOSPITAL FOUNDATION HAD 21 BOARD MEMBERS THAT VOLUNTEERED THEIR TIME AS BOARD MEMBERS DURING THE YEAR. ANOTHER 8 VOLUNTEERS ASSISTED WITH SPECIAL EVENTS. FORM 990, PART V, LINES 2A AND 2B: EMPLOYEES ARE PAID THROUGH THE USE OF A COMMON PAYMASTER AND REPORTED ON THE FORM W-3 AND OTHER REQUIRED FILINGS OF OVERLAKE HOSPITAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 ALTHOUGH THE GOVERNING DOCUMENTS DO NOT STATE THAT THERE ARE ANY MEMBERS OF OVERLAKE HOSPITAL FOUNDATION, OVERLAKE HOSPITAL MEDICAL CENTER DOES HAVE THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE. FORM 990, PART VI, SECTION A, LINE 7A OVERLAKE HOSPITAL MEDICAL CENTER HAS THE RIGHT TO APPOINT AND REMOVE OVERLAKE HOSPITAL FOUNDATION'S TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B OVERLAKE HOSPITAL MEDICAL CENTER MUST APPROVE: (A) ANY SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (B) ANY SINGLE TRANSACTION INCREASING LONG TERM INDEBTEDNESS BY AN AMOUNT EXCEEDING FIVE PERCENT OF THE TOTAL ASSETS OF THE CORPORATION DURING A FISCAL YEAR OF THE CORPORATION; (C) THE ANNUAL BUDGET OF THE CORPORATION AND ANY MATERIAL AMENDMENTS THERETO; (D) THE AUDITORS OF THE CORPORATION; AND (E) ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN REVIEWED BY THE CHIEF DEVELOPMENT OFFICER, PRESIDENT & CEO, CFO, OVERLAKE HOSPITAL MEDICAL CENTER CHIEF HUMAN RESOURCES AND COMPLIANCE OFFICER, AND THE OVERLAKE HOSPITAL MEDICAL CENTER AUDIT & COMPLIANCE COMMITTEE. A PUBLIC DISCLOSURE COPY IS DISTRIBUTED TO THE FOUNDATION 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 FINANCIAL INTERESTS OR 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 FOR 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 CHAIRMAN, COMMITTEE CHAIRS, AND THE CFO. 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 B, LINE 15A OVERLAKE'S POLICY AND PROCESS FOR EXECUTIVE COMPENSATION IS FULLY DOCUMENTED IN THE "EXECUTIVE COMPENSATION ADMINISTRATION AND COMPLIANCE MANUAL". THIS MANUAL DETAILS THE CHARTER OF THE COMPENSATION COMMITTEE OF THE BOARD, THE COMPENSATION PHILOSOPHY AND HOW SALARY INCREASES, INCENTIVES, BENEFITS AND PERQUISITES ARE ADMINISTERED. COMPENSATION COMMITTEE MEMBERS ARE INDEPENDENT BOARD MEMBERS AS REQUIRED BY THE CHARTER AND BY-LAWS. THE PROCESS INCLUDES AN INDEPENDENT CONSULTANT WHO WORKS DIRECTLY FOR THE COMPENSATION COMMITTEE AND REVIEW OF COMPARABLE DATA FROM EXTERNAL SOURCES. ALL COMPENSATION RELATED DECISIONS FOR THE FOUNDATION'S CHIEF DEVELOPMENT OFFICER MARY BETH STEARNS ARE DELIBERATED AND VOTED ON BY THE OVERLAKE HOSPITAL MEDICAL CENTER/OVERLAKE HOSPITAL ASSOCIATION/OVERLAKE HOSPITAL FOUNDATION COMPENSATION COMMITTEE AND DOCUMENTED IN THE MINUTES OF THE MEETING. OFFICERS J. MICHAEL MARSH AND ANDREW TOKAR ARE PAID BY RELATED AFFILIATE OVERLAKE HOSPITAL MEDICAL CENTER. THE MOST RECENT COMPENSATION REVIEW WAS AT THE OCTOBER 2017 COMPENSATION COMMITTEE MEETING. FORM 990, PART VI, SECTION C, LINE 19 OVERLAKE HOSPITAL FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE THROUGH THE HOSPITAL'S ADMINISTRATION OFFICE. THE OVERLAKE HOSPITAL FOUNDATION FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII: OVERLAKE HOSPITAL FOUNDATION STAFF ARE PAID BY ITS RELATED ORGANIZATION (OVERLAKE HOSPITAL MEDICAL CENTER) THROUGH A COMMON PAYMASTER. THESE PAYROLL EXPENSES ARE CHARGED TO OVERLAKE HOSPITAL FOUNDATION. FORM 990, PART IX, LINE 8: EMPLOYEES OF OVERLAKE HOSPITAL FOUNDATION RECEIVE PENSION BENEFITS ADMINISTERED THROUGH OVERLAKE HOSPITAL MEDICAL CENTER. THESE EXPENSES ARE INCLUDED IN THE OVERLAKE HOSPITAL MEDICAL CENTER IRS FORM 990, ARE NOT ALLOCATED TO THE OVERLAKE HOSPITAL FOUNDATION, AND ARE NOT REIMBURSED TO OVERLAKE HOSPITAL MEDICAL CENTER. FORM 990, PART XI, LINE 9: PRIOR YEAR PLEDGE WRITE-OFF -3,569. OVERLAKE HOSPITAL MEDICAL CENTER 1035 116TH AVENUE NE BELLEVUE WA 98004 910652651 HOSPITAL WA 501(C)(3) LINE 3 OVERLAKE HOSPITAL ASSOCIATION 0 OVERLAKE HOSPITAL AUXILIARIES 1035 116TH AVENUE NE BELLEVUE WA 98004 237297831 FUNDRAISING WA 501(C)(3) LINE 7 OVERLAKE HOSPITAL MEDICAL CENTER 0 OVERLAKE HOSPITAL ASSOCIATION 1035 116TH AVENUE NE BELLEVUE WA 98004 911274134 RENT MEDICAL & OFFICE SPACE TO HOSPITAL WA 501(C)(3) LINE 12B, II N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0