OVERLAKE HOSPITAL FOUNDATION: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
OVERLAKE HOSPITAL FOUNDATION (EIN 91-1050325)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-12
IRS object ID
201141329349303379
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-12T14:02:48-07:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Clark Nuber PSBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line110900 NE 4th StreetAddressLine1
CityBellevueCity
StateWAState
ZIP Code98004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN911050325EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Overlake Hospital FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlOVERNameControl
Phone4256885000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11035 - 116th Avenue NEAddressLine1
CityBellevueCity
StateWAState
ZIP Code98004ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGary McLaughlinName
TitleCFOTitle
Date Signed2011-05-12DateSigned
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDavid AubreyNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11035 - 116th Ave NEAddressLine1
CityBellevueCity
StateWAState
ZIP Code98004ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2907633GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501cXOrganization501c
Web Sitewww.overlakehospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1978YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionThe 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body22NbrVotingMembersGoverningBody
Nbr Independent Voting Members21NbrIndependentVotingMembers
Total Nbr Employees11TotalNbrEmployees
Total Nbr Volunteers25TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year2891956ContributionsGrantsPriorYear
Contributions Grants Current Year2489157ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year244107InvestmentIncomePriorYear
Investment Income Current Year173493InvestmentIncomeCurrentYear
Other Revenue Current Year-27912OtherRevenueCurrentYear
Total Revenue Prior Year3136063TotalRevenuePriorYear
Total Revenue Current Year2634738TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year3662924GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1922656GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year950163SalariesEtcPriorYear
Salaries Etc Current Year1041527SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year775345TotalFundrsngExpCurrentYear
Other Expense Prior Year390473OtherExpensePriorYear
Other Expenses Current Year273631OtherExpensesCurrentYear
Total Expenses Prior Year5003560TotalExpensesPriorYear
Total Expenses Current Year3237814TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1867497RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-603076RevenuesLessExpensesCY
Total Assets BOY8450918TotalAssetsBOY
Total Assets EOY8331487TotalAssetsEOY
Total Liabilities BOY186503TotalLiabilitiesBOY
Total Liabilities EOY224972TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8264415NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8106515NetAssetsOrFundBalancesEOY
Mission DescriptionThe 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1922656Expense
Grants1922656Grants
DescriptionOverlake Hospital Foundation raised $1,574,927 in contributions / pledges from donors. The Foundation provided $1,922,656 of financial support to Overlake Hospital Medical Center for new facilities, modern equipment and comprehensive services and programs. The difference is due to the payments of prior year pledges.Description
Total Program Service Expense1922656TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees11NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Nbr Voting Governing Body Members22NbrVotingGoverningBodyMembers
Number Independent Voting Members21NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledWAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonEric TeshimaNamePerson
Telephone Number4256885149TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11120 - 112th Ave NE Suite 202AddressLine1
CityBellevueCity
StateWAState
ZIP Code98004ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeOfficerOfficer
Vicki Orrico
Trustee0.25X000
Tom Fowler
Trustee0.25X000
Ted Herb
Trustee1.00X000
TJ Woosley
Trustee2.00X000
Susan Smith
Trustee2.00X000
Sue Raschella
Trustee3.00X000
Shelley Agricola MD
Trustee0.50X000
Roger Stark MD
Trustee1.00X000
Roger Anderson
Trustee1.50X000
Richards Larry
Dept. Director40.00113741018416X
Philip Corneil
Secretary1.50X000X
Peter Glidden
Trustee2.00X000
Peggy Swistak
Trustee1.00X000
Patricia Edwards
Trustee1.00X000
Ned Clapp
Trustee0.75X000
Michael Wallingford
Trustee1.00X000
Linda Mahaffey
Chairman3.00X000X
Laura Allison
Trustee0.25X000
John Nelson MD
Trustee1.00X017123040111
Jody Cunningham
Trustee2.00X000
Joan Albee
Treasurer1.00X000X
Jim Hill
Trustee0.25X000
Jason Thompson
Trustee3.00X000
Gregory Collins
Trustee3.00X000
Gary McLaughlin
CFO50.000598236141266X
David Aubrey
Executive Direc50.00312896068713X
Craig Hendrickson
President & CEO70.000913438182735X
Charles Royer
Trustee3.00X000
Alice Harris
Trustee2.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org426637TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1682904TotalReportableCompFrmRltdOrgs
Total Other Compensation451241TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Federated Campaigns804FederatedCampaigns
Fundraising Events301154FundraisingEvents
Related Organizations1466034RelatedOrganizations
All Other Contributions721165AllOtherContributions
Noncash Contributions77432NoncashContributions
Total Contributions2489157TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column162607TotalRevenueColumn
Exclusion$162,607ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities203664Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities192778Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities10886Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column10886TotalRevenueColumn
Exclusion$10,886ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events52205GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events301154CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses80117FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-27912TotalRevenueColumn
Exclusion-$27,912ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2634738TotalRevenueColumn
Exclusion$145,581ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1922656Total
Program Services1922656ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total287693Total
Management And General172616ManagementAndGeneral
Fundraising115077Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total635159Total
Management And General155545ManagementAndGeneral
Fundraising479614Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total71909Total
Management And General20653ManagementAndGeneral
Fundraising51256Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total46766Total
Management And General11249ManagementAndGeneral
Fundraising35517Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total392Total
Management And General321ManagementAndGeneral
Fundraising71Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total50222Total
Management And General14026ManagementAndGeneral
Fundraising36196Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total5000Total
Fundraising5000Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total25302Total
Management And General13203ManagementAndGeneral
Fundraising12099Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total17798Total
Fundraising17798Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total95938Total
Management And General95938ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total4725Total
Management And General637ManagementAndGeneral
Fundraising4088Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total3231Total
Fundraising3231Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total24468Total
Management And General24468ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraising
Misc. Expenses1498331514668
Membership Dues3157230842730

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3237814Total
Program Services1922656ProgramServices
Management And General539813ManagementAndGeneral
Fundraising775345Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY23720BOY
EOY48940EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY441396BOY
EOY255232EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1302734BOY
EOY385545EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY32969BOY
EOY20394EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis367053LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec234840LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY80567BOY
EOY132213EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY6559195BOY
EOY7479159EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY10337BOY
EOY10004EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8450918BOY
EOY8331487EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY48250BOY
EOY47074EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY138253BOY
EOY177898EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY186503BOY
EOY224972EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2606131BOY
EOY2823563EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1159496BOY
EOY677835EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4498788BOY
EOY4605117EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8264415BOY
EOY8106515EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8450918BOY
EOY8331487EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5544176CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7840762CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7326841CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2891956CurrentTaxYearMinus1Year
Current Tax Year2489157CurrentTaxYear
Total26092892Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5544176CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7840762CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7326841CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2891956CurrentTaxYearMinus1Year
Current Tax Year2489157CurrentTaxYear
Total26092892Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total5486246AmountsSubstContributorsTotal
Public Support Total17020606646PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years160546CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years288821CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years324783CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year211367CurrentTaxYearMinus1Year
Current Tax Year162607CurrentTaxYear
Total1148124Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support27241016TotalSupport
Public Support Pertcentage1700.75650PublicSupportPertcentage170
Public Support Pertcent Prior Year0.77470PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6354334BeginningOfYearBalance
Contributions149314Contributions
Investment Earnings Or Losses620157InvestmentEarningsOrLosses
Other Expenditures-47756OtherExpenditures
End Of Year Balance7076049EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance7478956BeginningOfYearBalance
Contributions114720Contributions
Investment Earnings Or Losses-1007582InvestmentEarningsOrLosses
Other Expenditures-231760OtherExpenditures
End Of Year Balance6354334EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.31000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.69000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis154803OtherCostOrOtherBasis
Depreciation97912Depreciation
Book Value56891BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis212250OtherCostOrOtherBasis
Depreciation136928Depreciation
Book Value75322BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings132213TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4Part V, Line 4: Intended uses of the endowment fund.Endowment distributions are used to support capital and operational needs of Overlake Hospital Medical Center as directed by the individual Endowment purpose.
Part IV, Line 2bPart IV, Line 2b: Explanation of escrow account liabilityAnnuities and Trust are held in a custodial account (BNY Mellon). The assets and liability are reported on the balance sheet.

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Agreement Ref FundraisingfalseAgreementRefFundraising

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Corporate Partners Breakfast.NameOfEvent1
Gross Receipts Event1353359GrossReceiptsEvent1
Charitable Contributions Event1301154CharitableContributionsEvent1
Gross Revenue Event152205GrossRevenueEvent1
Food And Beverage Event152205FoodAndBeverageEvent1
Other Direct Expenses Event127912OtherDirectExpensesEvent1
Gross Receipts Total353359GrossReceiptsTotal
Charitable Contributions Total301154CharitableContributionsTotal
Gross Revenue Total Events52205GrossRevenueTotalEvents
Food And Beverage Total Events52205FoodAndBeverageTotalEvents
Other Direct Expenses Total Events27912OtherDirectExpensesTotalEvents
Direct Expense Summary Events80117DirectExpenseSummaryEvents
Net Income Summary-27912NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Overlake Hospital Medical CenterBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11035 - 116th Ave NEAddressLine1
CityBellevueCity
StateWAState
ZIP Code98004ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient910655265EINOfRecipient
IRC Section501 (c)(3)IRCSection
Amount Of Cash Grant1909156AmountOfCashGrant
Amount Of Non Cash Assistance13500AmountOfNonCashAssistance
Method Of ValuationFair Market ValueMethodOfValuation
Description Of Non Cash AssistanceAirline tickets and Media coverageDescriptionOfNonCashAssistance
Purpose Of GrantSupport Overlake HospitalPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierGrantmaker's Description of How Grants are UsedIdentifier
ExplanationOverlake Hospital Foundation staff notifies the Overlake Hospital Medical Center Accounting staff when there is a specific grant. If the grant is for operational expenses, the appropriate department in the hospital is contacted. 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
John Nelson MD
144670262932672626913842211341
Gary McLaughlin
4081407841711167931221110045739502
David Aubrey
23451530155482262980338910381609
Craig Hendrickson
606450168415138573376071451281096173

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSch J, Part I, Line 7Identifier
Return ReferencePart I, Line 7: Non-Fixed payments not listed aboveReturnReference
ExplanationManagement incentive for the CEO, CFO, and Executive Director are contingent on Overlake Hospital Association's consolidated net operating income for the fiscal year being at least 80% of the net operating income budget. The incentive payment is then based on a combination of meeting organization and individual goals.Explanation

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions6NumberOfContributions
Noncash Contribs Rptd F99063932NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XMedia Promotion112500FMV
XAirline Ticket11000FMV
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableOverlake Hospital Foundation makes its governing documents, conflict of interest policy, and audited financial statements available through the Hospital's administration office.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesOverlake's policy and process for Executive Compensation is fully documented in the "Executive Compensation Administration and Compliance Manual" which was last updated on 7/1/09. This manual details the charter of the Compensation Committee of the Board, the compensation philosophy and how salary increases, incentives, benefits and prerequisites 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 a review of comparable data from external sources. All compensation related decisions for the CEO, COO and Vice Presidents and Foundation Executive Director are discussed, deliberated and voted on by the Compensation Committee and documented in the minutes of the meeting.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsEducation regarding conflicts of interest is provided at the annual meeting in January of each year to the full board. Conflict of interest statements are signed annually by Board members at the beginning of the calendar year and submitted to Overlake Hospital Medical Center's Chief Compliance Officer for review. The Chief Compliance Officer summarizes any conflicts of interest and discusses these results with the Chair of the Audit & Compliance Committee, CEO, and Legal Counsel. At Board meetings, members are reminded that they should recuse themselves from voting on issues when there is a conflict of interest.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessThe 990 is prepared internally and reviewed by an independent accounting firm. The 990 is then reviewed by Executive Director, President & CEO, CFO, and Overlake Hospital Medical Center Finance Committee. The 990 is sent to the Foundation Board members prior to submission to the IRS.
Form 990, Part VI, Line 7aForm 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyOverlake Hospital Medical Center has the right to appoint and remove Overlake Hospital Foundation's Trustees.
Form 990, Part VI, Line 6Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderOverlake Hospital Medical Center is the sole member of Overlake Hospital Foundation.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Overlake Hospital Association
1035 - 116th Ave NEBellevueWA98004911274134Rent Medical and office space to HospitalWA501(c)(3)11NA
Overlake Hospital Auxiliaries
1035 - 116th Ave NEBellevueWA98004237297831Fund RaisingWA503(c)(3)9Overlake Hospital Medical Center
Overlake Hospital Medical Center
1035 - 116th Ave NEBellevueWA98004910652651HospitalWA501(c)(3)3Overlake Hospital Association

Form990 Schedule R Part III Form990ScheduleRPartIII

FieldValueIRS element (for citing)
Direct Controlling Entity NAN/ADirectControllingEntityNA
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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