TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) J MICHAEL MARSH...................................................................... PRESIDENT & CEO	45.00 ................. 15.00		X				1,314,369	140,806
(2) ASIF ALI KHAN MD...................................................................... NEUROSURGEON	40.00 ................. 0.00				X		1,059,401	34,475
(3) DEREK M RODRIGUES MD...................................................................... CARDIOLOGIST	40.00 ................. 0.00				X		1,013,842	39,373
(4) AMITOZ SINGH MANHAS MD...................................................................... NEUROSURGEON	40.00 ................. 0.00				X		915,950	34,475
(5) DAVID W NELSON MD...................................................................... CARDIOLOGIST	40.00 ................. 0.00				X		891,483	39,373
(6) ROBERT S BINFORD MD...................................................................... CARDIOLOGIST	40.00 ................. 0.00				X		805,105	40,275
(7) THOMAS A DEBORD...................................................................... COO	55.00 ................. 0.00		X				738,528	92,930
(8) DAVID A KNOEPFLER...................................................................... FORMER KEY EMPLOYEE	55.00 ................. 0.00					X	736,623	90,164
(9) KELAN R KOENIG MD...................................................................... OMC PHYSICIAN EXECUTIVE	55.00 ................. 0.00			X			618,794	101,899
(10) ANDREW J TOKAR...................................................................... CFO	50.00 ................. 7.00		X				592,130	85,014
(11) MICHELLE CURRY...................................................................... VP/CHIEF NURSING OFFICER	55.00 ................. 0.00			X			374,430	63,208
(12) VALERIE CHRUSCIEL...................................................................... OMC COO	60.00 ................. 0.00			X			360,709	67,328
(13) ROBERT CAMPBELL...................................................................... CHAIR	5.00 ................. 5.00	X	X				0	0
(14) JASON THOMPSON...................................................................... SECRETARY & TREASURER	3.00 ................. 0.50	X	X				0	0
(15) RUSSELL STOCKDALE...................................................................... IMMEDIATE PAST CHAIR	3.00 ................. 1.00	X	X				0	0
(16) RONNIER AVILES...................................................................... TRUSTEE THRU 12/21	2.00 ................. 2.00	X					0	0
(17) PAULINE BACH...................................................................... TRUSTEE	2.00 ................. 1.00	X					0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)
(18) PATRICIA BEDIENT........................................................................ TRUSTEE	1.00 .......................1.00	X
(19) KRISTINA BELFIORE........................................................................ TRUSTEE	1.50 .......................0.50	X
(20) JAMES BOSWELL........................................................................ TRUSTEE	2.00 .......................2.00	X
(21) RAJ BUTANI MD........................................................................ TRUSTEE	3.00 .......................0.50	X
(22) JORGE CERDA........................................................................ TRUSTEE	8.00 .......................8.00	X
(23) ANNETTE CLARK........................................................................ TRUSTEE	2.00 .......................2.00	X
(24) TOM EVERT........................................................................ TRUSTEE	3.00 .......................0.50	X
(25) VINCE FARINAS........................................................................ TRUSTEE THRU 12/21	2.00 .......................0.50	X
(26) TED HERB........................................................................ TRUSTEE	2.00 .......................2.00	X
(27) RAJESH JHA........................................................................ TRUSTEE	2.00 .......................1.00	X
(28) TIFFANY KOENIG........................................................................ TRUSTEE	1.50 .......................0.50	X
(29) JIM LADD........................................................................ TRUSTEE	2.00 .......................2.00	X
(30) MARTHA LEE........................................................................ TRUSTEE	3.00 .......................3.00	X
(31) LINDA MAHAFFEY........................................................................ TRUSTEE	1.50 .......................1.00	X
(32) UMA RAGHAVAN........................................................................ TRUSTEE	4.00 .......................0.50	X
(33) ERIC SHIPLEY........................................................................ TRUSTEE	3.00 .......................0.50	X
(34) LISA WISSNER-SLIVKA........................................................................ TRUSTEE	3.00 .......................0.50	X
(35) DILIP WAGLE........................................................................ TRUSTEE	2.00 .......................1.00	X
(36) JESSIE WOOLLEY-WILSON........................................................................ TRUSTEE	2.00 .......................2.00	X

(A) Name and business address	(B) Description of services	(C) Compensation
BONEWITZ LLC PO BOX 1620 MERCER ISLAND,WA98040	CONSTRUCTION	2,090,607
NBBJ PO BOX 742088 LOS ANGELES,CA90074	CONSTRUCTION	1,834,823
FLEXCARE MEDICAL STAFFING PO BOX 203684 DALLAS,TX75320	MEDICAL STAFFING	1,716,193
IVOXY CONSULTING LLC PO BOX 101264 PASADENA,CA91189	INFORMATION SYSTEMS	1,247,040
TRIAGE 12020 PACIFIC STREET OMAHA,NE68154	MEDICAL STAFFING	1,121,114
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 186

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization OVERLAKE HOSPITAL MEDICAL CENTER

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization OVERLAKE HOSPITAL MEDICAL CENTER		Employer identification number 91-0652651

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization OVERLAKE HOSPITAL MEDICAL CENTER			Employer identification number 91-0652651
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

26,508

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

26,508

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	PART OF MEMBERSHIP DUES THAT ARE PAID TO WASHINGTON STATE HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING PURPOSES.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	3,056,141		3,056,141
b	Buildings ....	490,352,305	151,738,680	338,613,625
c	Leasehold improvements	4,554,645	4,192,236	362,409
d	Equipment ....	312,203,699	239,092,800	73,110,899
e	Other .....	10,513,719		10,513,719
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				425,656,793

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	54,283,773
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	5,544,762		5,544,762	0.780 %
b	Medicaid (from Worksheet 3, column a) . . . . .	70,103,918	36,611,086	33,492,832	4.690 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	75,648,680	36,611,086	39,037,594	5.470 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,030,431	115,223	915,208	0.130 %
f	Health professions education (from Worksheet 5) . . .	2,366,030		2,366,030	0.330 %
g	Subsidized health services (from Worksheet 6) . . . .	1,981,034	1,200,732	780,302	0.110 %
h	Research (from Worksheet 7) .	56,226	120,627	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	621,375		621,375	0.090 %
j	Total. Other Benefits . .	6,055,096	1,436,582	4,682,915	0.660 %
k	Total. Add lines 7d and 7j .	81,703,776	38,047,668	43,720,509	6.130 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,770,411

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

3,488,602

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

71,139,708

Enter Medicare allowable costs of care relating to payments on line 5.....

78,091,633

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-6,951,925

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	OVERLAKE HOSPITAL MEDICAL CENTER 1035 116TH AVE NE BELLEVUE,WA98004 OVERLAKE HOSPITAL.ORG/ABOUT-OVERLAKE HAC.FS.00000131	X	X	X	X	X

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	OVERLAKE HOSPITAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): OVERLAKEHOSPITAL.ORG/ABOUT/COMMUNITY-BENEFIT

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): OVERLAKEHOSPITAL.ORG/ABOUT/COMMUNITY-BENEFIT

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	OVERLAKE HOSPITAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

OVERLAKEHOSPITAL.ORG/VISIT/BILLING-INSURANCE/FINANCIAL-ASSISTANCE

The FAP application form was widely available on a website (list url):

OVERLAKEHOSPITAL.ORG/VISIT/BILLING-INSURANCE/FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
OVERLAKEHOSPITAL.ORG/VISIT/BILLING-INSURANCE/FINANCIAL-ASSISTANCE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	OVERLAKE HOSPITAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	OVERLAKE HOSPITAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
OVERLAKE HOSPITAL MEDICAL CENTER	PART V, SECTION B, LINE 5: OVERLAKE MEDICAL CENTER SOLICITED COMMUNITY INPUT THROUGH KEY STAKEHOLDER INTERVIEWS TO IDENTIFY RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE SIGNIFICANT HEALTH NEEDS. OVERLAKE MEDICAL CENTER PARTICIPATED IN A COLLABORATIVE PROCESS FOR COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF THE KING COUNTY HOSPITALS FOR A HEALTHIER COMMUNITY (HHC). HHC IS A COLLABORATIVE OF ALL 10 HOSPITALS AND/OR HEALTH SYSTEM IN KING COUNTY AND PUBLIC HEALTH-SEATTLE & KING COUNTY. THE HHC MEMBERS JOINED TOGETHER TO IDENTIFY IMPORTANT HEALTH NEEDS AND ASSETS IN THE COMMUNITIES THEY SERVE. HHC RECOGNIZES THAT PARTNERSHIPS BETWEEN HOSPITALS, PUBLIC HEALTH, COMMUNITY ORGANIZATIONS AND COMMUNITIES AND COMMUNITIES ARE KEY TO SUCCESSFUL STRATEGIES TO ADDRESS COMMON HEALTH NEEDS. THE COMMUNITY HEALTH NEEDS ASSESSMENT INCORPORATED EXISTING DEMOGRAPHIC AND HEALTH DATA FOR THE COMMUNITIES SERVED BY THE HOSPITAL. IT INCLUDED COLLECTION AND ANALYSIS OF INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH. THE HEALTH NEEDS WERE IDENTIFIED FROM ISSUES SUPPORTED BY PRIMARY AND SECONDARY DATA SOURCES GATHERED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS WERE INDICATED BY STAKEHOLDER INTERVIEWS, FOCUS GROUPS, AND SECONDARY DATA SOURCES. THE NEEDS WERE CONFIRMED BY MORE THAN ONE INDICATOR OR DATA SOURCE. COMMUNITY STAKEHOLDER, IDENTIFIED BY THE HOSPITAL, WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT. INTERVIEW PARTICIPANTS INCLUDED LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AS WELL AS THE LOCAL HEALTH DEPARTMENT THAT HAS "CURRENT DATA OR INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY," PER IRS REQUIREMENTS. THE INTERVIEWS TOOK INTO ACCOUNT INPUT FROM A BROAD RANGE OF PERSONS LOCATED IN OR SERVING ITS COMMUNITY INCLUDING, HEALTH CARE CONSUMERS, NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, ACADEMIC EXPERTS, LOCAL GOVERNMENT OFFICIALS, LOCAL SCHOOL DISTRICTS, HEALTH CARE PROVIDERS AND COMMUNITY HEALTH CENTERS.
OVERLAKE HOSPITAL MEDICAL CENTER	PART V, SECTION B, LINE 6A: EVERGREEN HEALTH, CHI FRANCISCAN HEALTH, KAISER PERMANENTE, MULTICARE HEALTH SYSTEMS, NAVOS, FRED HUTCHINSON CANCER CENTER (FKA: SEATTLE CANCER CARE ALLIANCE), SEATTLE CHILDREN'S, SWEDISH MEDICAL CENTER, UW MEDICINE, VIRGINIA MASON
OVERLAKE HOSPITAL MEDICAL CENTER	PART V, SECTION B, LINE 6B: PUBLIC HEALTH-SEATTLE & KING COUNTY, WASHINGTON STATE HOSPITAL ASSOCIATION
OVERLAKE HOSPITAL MEDICAL CENTER	PART V, SECTION B, LINE 11: COMMUNITY DEFINITION:THE SERVICE AREA FOR OVERLAKE MEDICAL CENTER IS DIVIDED INTO TWO MARKETS LOCAL AND OUTLYING WITH THE LOCAL MARKET DIVIDED INTO FIVE SERVICE AREAS (BELLEVUE, EAT, ISSAQUAH/SAMMAMISH, REDMOND/KIRKLAND, AND SW) AND THE OUTLYING MARKET DIVIDED INTO TWO SERVICE AREAS (NORTH AND SOUTH). THE SEVEN SERVICE AREAS INCLUDE 26 CITIES/COMMUNITIES AND AN ASSOCIATED 44 ZIP CODES. THE SERVICE AREA WAS DETERMINED FROM ZIP CODES THAT REFLECT A MAJORITY OF PATIENT ADMISSIONS.ASSESSMENT PROCESS AND METHODS:SECOND AND PRIMARY DATA WERE COLLECTED TO COMPLETE THE CHNA. SECONDARY DATA WERE COLLECTED FROM A VARIETY OF LOCAL, COUNTY AND STATE SOURCES TO PRESENT COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH, HEALTH CARE ACCESS, BIRTH CHARACTERISTICS, LEADING CAUSES OF DEATH, CHRONIC DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE AND PREVENTIVE PRACTICES. THE ANALYSIS OF SECONDARY DATA YIELDED A PRELIMINARY LIST OF SIGNIFICANT HEALTH NEEDS, WHICH THEN INFORMED PRIMARY DATA COLLECTION.PRIMARY DATA WERE OBTAINED THROUGH INTERVIEWS WITH COMMUNITY STAKEHOLDERS TO OBTAIN INPUT ON HEALTH NEEDS, BARRIERS TO CARE AND RESOURCES AVAILABLE TO ADDRESS THE IDENTIFIED HEALTH NEEDS. THIRTEEN (13) INTERVIEWS WERE COMPLETED IN NOVEMBER AND DECEMBER 2020. THE PRIMARY DATA COLLECTION PROCESS WAS DESIGNED TO VALIDATE SECONDARY DATA FINDINGS, IDENTIFY ADDITIONAL COMMUNITY ISSUES, SOLICIT INFORMATION ON DISPARITIES AMONG SUBPOPULATIONS, ASCERTAIN COMMUNITY ASSETS POTENTIALLY AVAILABLE NEEDS AND DISCOVER GAPS IN RESOURCES.PRIORITY HEALTH NEEDS: THE COMMUNITY STAKEHOLDERS PRIORITIZED THE HEALTH NEEDS ACCORDING TO HIGHEST LEVEL OF IMPORTANCE IN THE COMMUNITY. COVID-19, ACCESS TO HEALTH CARE, MENTAL HEALTH, PREVENTIVE PRACTICES, AND SUBSTANCE USE WERE RANKED AS THE TOP FIVE PRIORITY NEEDS IN THE SERVICE AREA.MENTAL HEALTH - INCREASE ACCESS TO MENTAL HEALTHCARE RESOURCES AND SERVICES. OVERLAKE WILL IMPLEMENT A MENTAL HEALTH COMMUNITY PROGRAM TO DELIVER A SUICIDE PREVENTION CURRICULUM IN CONJUNCTION WITH LOCAL SCHOOLS AND COMMUNITY MENTAL HEALTH SERVICES. EXPAND ACCESS TO EARLY INTERVENTION AND SCREENING AND OTHER MENTAL HEALTH SERVICES- ESPECIALLY TO YOUTH THROUGH OUR PARTNERSHIP WITH YOUTH EASTSIDE SERVICES. DEVELOP A PROGRAM TO OFFER DEMENTIA AND ALZHEIMER'S DISEASE PREVENTION EDUCATION. CONTINUE AND EXPAND CAREGIVER SUPPORT PROGRAMS THROUGH COLLABORATION WITH AEGIS, SEAMAR AND YMCA. PROVIDE SUPPORTIVE SERVICES FOR CAREGIVERS OF PERSONS WITH DEMENTIA. SUPPORT COMMUNITY ORGANIZATIONS THAT PROVIDE MENTAL HEALTH SERVICES.ACCESS TO CARE - INCREASE ACCESS TO HEALTHCARE FOR THE MEDICALLY UNDERSERVED WITH A FOCUS ON THE CULTURALLY DIVERSE POPULATIONS OF THE EASTSIDE. OVERLAKE WILL EXPAND OUTREACH ACTIVITIES WITH SOUTH ASIAN AND SOUTHEAST ASIAN POPULATIONS IN PARTNERSHIP WITH COMMUNITY ORGANIZATIONS. OVERLAKE WILL PROVIDE FINANCIAL ASSISTANCE BY OFFERING FREE AND DISCOUNTED CARE FOR HEALTHCARE SERVICES, CONSISTENT WITH OVERLAKE'S FINANCIAL ASSISTANCE POLICY.CARDIOVASCULAR DISEASE - DECREASE HEART DISEASE AMONG VULNERABLE EASTSIDE POPULATIONS. OVERLAKE WILL: IMPLEMENT EDUCATION AND OUTREACH PROGRAMS TARGETED TO THE SOUTH ASIAN POPULATION (IDENTIFIED WITH A HIGHER RELATIVE RISK), CONTINUE TO OFFER OVERLAKE'S WOMEN AND HEART SYMPOSIUM, AND PARTICIPATED IN AND SPONSOR EDUCATION PROGRAMS WITH THE AMERICAN HEART ASSOCIATION.PREVENTIVE HEALTHCARE - INCREASE ACCESS TO CLINICAL PREVENTIVE SERVICES TO REDUCE DEATH, DISABILITY, AND DISEASE. OVERLAKE WILL COMMIT THE FOLLOWING RESOURCES TO ADDRESS THIS HEALTH NEED BY PROVIDING FREE FLU AND PNEUMOCOCCAL VACCINES TO THE MEDICALLY UNDERSERVED, OFFER SENIOR WELLNESS PROGRAMS, OFFER COLORECTAL CANCER SCREENINGS TARGETED TO THE HIGH RISK MEMBERS OF THE SOUTHEAST ASIAN COMMUNITY, PROVIDE FREE DISEASE PREVENTION AND AWARENESS PROGRAMS THROUGH PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS SUCH AS THE AMERICAN CANCER SOCIETY AND THE AMERICAN HEART ASSOCIATION, AND CONDUCT EDUCATION FOCUSED ON SMOKING AND VAPING PREVENTION AMONG YOUTH.OTHER HEALTH NEEDS - OVERLAKE HOSPITAL MEDICAL CENTER HAS CHOSEN NOT TO ACTIVELY ADDRESS THE REMAINING HEALTH NEEDS OF OVERWEIGHT AND OBESITY AND SEXUALLY TRANSMITTED INFECTIONS AS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, OVERLAKE WILL CONCENTRATE ON THOSE HEALTH NEEDS THAT WE CAN MOST EFFECTIVELY ADDRESS GIVEN OUR AREAS OF FOCUS AND EXPERTISE. THEREFORE, THE HOSPITAL'S CHARITABLE RESOURCES WILL BE PLACED ON THE SELECTED PRIORITY HEALTH NEEDS.
OVERLAKE HOSPITAL MEDICAL CENTER	PART V, SECTION B, LINE 13H: EXCEPTIONS TO THE WASHINGTON STATE RESIDENCY REQUIREMENT ALSO INCLUDE REFUGEES, ASYLEES, AND THOSE SEEKING ASYLUM THAT POSSESS AND CAN PRESENT INS DOCUMENTATION.
PART V, SECTION B, LINE 3E:	CALCULATIONS FROM COMMUNITY STAKEHOLDERS RESULTED IN THE FOLLOWING PRIORITIZATION OF THE SIGNIFICANT HEALTH NEEDS:COVID-19, ACCESS TO HEALTH CARE, MENTAL HEALTH, PREVENTIVE PRACTICES, SUBSTANCE USE, HOUSING AND HOMELESSNESS, CANCER, SEXUALLY TRANSMITTED INFECTIONS, OVERWEIGHT AND OBESITY.

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?36
Name and address		Type of Facility (describe)
1	1 - OMC-URGENT & PRIMARY CARE ISSAQUAH 5708 E LK SAMMAMISH PKWY SE STE 100 ISSAQUAH,WA98029	URGENT/PRIMARY CARE
2	2 - OMC-CARDIOLOGY BELLEVUE 1135 116TH AVE NE STE 600 BELLEVUE,WA98004	CARDIOLOGY
3	3 - OMC-PULMENDOCRINOLOGYPRIMARY CARE 1231 116TH AVE NE STE 400 BELLEVUE,WA98004	PULMONOLOGY/ENDOCRINOLOGY/ PRIMARY CARE
4	4 - HOSPITALISTS 1231 116TH AVE NE STE 400 BELLEVUE,WA98005	HOSPITALIST
5	5 - OMC-NEUROLOGY 1135 116TH AVE NE STE 500 BELLEVUE,WA98004	NEUROLOGY/NEUROSURGERY/NEUROHOSPITAL
6	6 - OMC-DT BELLEVUE PRIMARYURGENT CARE 400 108TH AVE NE STE 100 BELLEVUE,WA98004	PRIMARY/URGENT CARE
7	7 - OMC-URGENT CARE REDMOND 17209 REDMOND WAY REDMOND,WA98052	URGENT CARE
8	8 - OMC PRIMARY CARE 1035 116TH AVE NE BELLEVUE,WA98004	PRIMARY CARE
9	9 - OMC-UROLOGY BELLEVUE 1135 116TH AVE NE STE 620 BELLEVUE,WA98004	UROLOGY
10	10 - OB-GYN BELLEGROVE 1200 112H AVE NE BLDG C BELLEVUE,WA98004	OBSTETRICS/GYNECOLOGY
11	11 - OMC-INTERNAL MEDICINE ASSOCIATES WASHINGTON PARK 1407 116TH AVENUE NE E- BELLEVUE,WA98004	INTERNAL MEDICINE
12	12 - OMC-NEWCASTLE URGENT & PRIMARY CARE 13167 NEWCASTLE COMMONS DR NEWCASTLE,WA98059	URGENT CARE/PRIMARY CARE
13	13 - OMC-RAD ONCOLOGY PHYSGYNMEDICALBREAST 1135 116TH AVE NE STE 200 BELLEVUE,WA98004	ONCOLOGY/BREAST SURGERY/GYNECOLOGY
14	14 - OMC-SPECIALTY CLINIC BELLEVUE 1231 116TH AVE NE SUITE 515 BELLEVUE,WA98004	BARIATRIC/METABOLIC SURGERY/MEDICAL WEIGHT LOSS
15	15 - OMC-REDMOND PRIMARY & CARDIOLOGY 7345 164TH AVE NE STE 1-105 REDMOND,WA98052	PRIMARY CARE/CARDIOLOGY
16	16 - OMC-MUSCULOSKELETAL MED ISSAQUAH 1740 NW MAPLE ST STE 111 ISSAQUAH,WA98027	MUSCULOSKELETAL MEDICINE
17	17 - OMC-OP PSYCH 1750 112TH AVE NE STE B-102 BELLEVUE,WA98004	PSYCH SERVICES
18	18 - OMC-OP PHYSSPEECHOCCUP THERAPY 1417 116TH AVE NE STE 110 BELLEVUE,WA98004	PHYSICAL/SPEECH/OCCUPATIONAL
19	19 - OMC-URGENT & PRIMARY CARE LAKE HILL 619 156TH AVE SE BELLEVUE,WA98007	URGENT CARE/PRIMARY CARE
20	20 - OMC-SLEEP MEDICINE 1100 112TH AVE NE STE 320 BELLEVUE,WA98004	SLEEP MEDICINE
21	21 - OMC-KIRKLAND PRIMARY CARECARDIOLOGY 290 CENTRAL WAY KIRKLAND,WA98033	PRIMARY CARE/CARDIOLOGY
22	22 - OMC-CARDIACTHORACIC SURGERY 1135 116TH AVE NE STE 605 BELLEVUE,WA98004	CARDIACTHORACIC SURGERY
23	23 - OMC-SAMMAMISH PRIMARY & URGENT CARE 22630 SE 4TH ST STE 300 SAMMAMISH,WA98074	PRIMARY CARE/URGENT CARE
24	24 - OMC-CONCIERGE SERVICES 1231 116TH AVE NE STE 525 BELLEVUE,WA98004	CONCIERGE SERVICES
25	25 - OMC-SENIOR HEALTH CLINIC BELLEVUE 1750 112TH AVE NE STE A101 BELLEVUE,WA98004	SENIOR HEALTH SERVICES
26	26 - OMC-CARDIOLOGYPULMSPECIALTY SERVICES 1740 NW MAPLE STE 207 ISSAQUAH,WA98027	CARDIOLOGY/PULM/SPECIALTY/NUTRITION/ENDO/UROLOGY
27	27 - OMC-UROLOGY KIRKLAND 13126 120TH AVE NE KIRKLAND,WA98034	UROLOGY
28	28 - OMC-COLORECTAL SURGERY 1135 116TH AVE NE STE 550 BELLEVUE,WA98004	COLORECTAL
29	29 - OMC-PELVIC HEALTH 1135 116TH AVE NE STE 510 BELLEVUE,WA98004	PELVIC HEALTH
30	30 - OMC-INFECTIOUS DISEASE 1135 116TH AVE NE STE 140 BELLEVUE,WA98004	INFECTIOUS DISEASE
31	31 - OMC-ACC PROVIDERS & HIGHMARK 1035 116TH AVE NE BELLEVUE,WA98004	ANTICOAGULATION CLINIC
32	33 - NEUROLOGY HIGHMARK 1740 NW MAPLE ST 2ND FL ISSAQUAH,WA98027	NEUROLOGY
33	34 - OMC-PALLIATIVE CARE 1035 116TH AVE NE BLDG 3 BELLEVUE,WA98004	PALLIATIVE CARE
34	35 - OMC-DERMATOLOGY 1035 116TH AVE NE BLDG 5 5TH FL BELLEVUE,WA98004	DERMATOLOGY
35	36 - OMC-EXPEDIA PRIMARY CARE 333 108TH AVE NE BELLEVUE,WA98004	PRIMARY CARE
36	37 - OMC-MUSCULOSKELETAL BELLEVUE 1035 116TH AVE NE BELLEVUE,WA98004	MUSCULOSKELETAL

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	IN ADDITION TO THE FPL CRITERIA, THERE IS A RESIDENCY REQUIREMENT TO EITHER BE A RESIDENT OF THE STATE OF WASHINGTON OR MEET AN EXCEPTION FOR NON-RESIDENTS. NON-RESIDENTS MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE WHILE RECEIVING SERVICES WITHIN THE EMERGENCY DEPARTMENT OR AS A RESULT OF A DIRECT ADMISSION FROM THE EMERGENCY DEPARTMENT. EXCEPTIONS TO THE WASHINGTON STATE RESIDENCY REQUIREMENT ALSO INCLUDE REFUGEES, ASYLEES, AND THOSE SEEKING ASYLUM THAT POSSESS AND CAN PRESENT INS DOCUMENTATION.
PART I, LINE 7:	THE COSTING METHODOLOGY FOR CHARITY CARE AND UNREIMBURSED MEDICAID WAS THE COST TO CHARGE METHOD USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. THE COMMUNITY HEALTH IMPROVEMENT COST, HEALTH PROFESSIONAL EDUCATION, RESEARCH AND CASH AND IN-KIND CONTRIBUTIONS ARE DIRECT COST AND DO NOT INCLUDE ANY INDIRECT COST. THE COST FOR SUBSIDIZED HEALTH SERVICES IS DERIVED FROM A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS.
PART III, LINE 2:	PATIENT BILLS ARE REDUCED BY PAYMENTS, CONTRACTUAL ADJUSTMENTS, CHARITY ADJUSTMENTS, AND OTHER ADJUSTMENTS AS APPLICABLE. PATIENTS ARE THEN RESPONSIBLE FOR ANY REMAINING BALANCE. IF A PATIENT DOES NOT PAY THE BALANCE OR MAKE PAYMENT ARRANGEMENTS ACCORDING TO THE COLLECTION POLICY, THE BALANCE IS WRITTEN OFF TO BAD DEBT. THE BAD DEBT EXPENSE ON SCHEDULE H, PART III, LINES 2 AND 3 ARE ESTIMATED BASED ON THE COST TO CHARGE RATIO.
PART III, LINE 3:	THE HOSPITAL BELIEVES THAT APPROXIMATELY 73.13% OF THE BAD DEBT EXPENSE ARE RELATED TO PATIENTS THAT WOULD BE ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE GUIDELINES HAD THE PATIENT PROVIDED THE FINANCIAL INFORMATION NECESSARY TO MAKE THE DETERMINATION. THIS PERCENTAGE IS BASED ON RUNNING CREDIT CHECKS ON A SAMPLE OF ACCOUNTS THAT WERE BEING SENT TO BAD DEBTS.
PART III, LINE 4:	THE ORGANIZATIONS AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE THAT DISCUSSES BAD DEBT EXPENSE. THE ORGANIZATION RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICES ON THE BASIS OF PAST EXPERIENCE, WHICH HAS HISTORICALLY INDICATED THAT MANY PATIENTS ARE UNRESPONSIVE OR ARE OTHERWISE UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. AS A RESULT OF ADOPTING ASU 2014 09, THE HOSPITAL AND THE CLINICS CONTINUE TO MAINTAIN AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RELATED TO PERFORMANCE OBLIGATIONS SATISFIED PRIOR TO JULY 1, 2019. ANY PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN 2022 AND 2021 WERE CONSIDERED TO BE IMPLICIT PRICE CONCESSIONS AND ARE RECORDED DIRECTLY TO NET PATIENT SERVICE REVENUE.
PART III, LINE 8:	THE COSTING METHODOLOGY FOR MEDICARE ALLOWABLE COST IS DERIVED FROM FY 2022 MEDICARE COST REPORT. THE HOSPITAL BELIEVES THAT ALL THE MEDICARE SHORTFALLS SHOULD BE TREATED AS COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO MEDICARE PATIENTS AND THE HOSPITAL CONTINUES PROVIDING CARE TO THE MEDICARE BENEFICIARIES REGARDLESS OF THE SHORTFALL. BY ABSORBING THE MEDICARE SHORTFALL, THE HOSPITAL THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES.
PART III, LINE 9B:	THE HOSPITAL WILL PLACE A PATIENT'S ACCOUNT ON HOLD WHEN A PATIENT'S ACCOUNT IS BEING CONSIDERED FOR CHARITY. ONCE A DETERMINATION HAS BEEN MADE THAT A PATIENT QUALIFIES FOR CHARITY CARE, THE PATIENT'S ACCOUNT IS REDUCED BY THE CHARITY AMOUNT GRANTED AND A LETTER IS SENT TO THE PATIENT NOTING THE CHARITY ADJUSTMENT. THE PATIENT MAY APPEAL THE DECISION IF HE/SHE BELIEVES THERE IS ADDITIONAL INFORMATION THAT SHOULD HAVE BEEN CONSIDERED OR THE FINANCIAL SITUATION HAS CHANGED. THE PATIENT IS RESPONSIBLE FOR ANY BALANCE REMAINING AFTER THE CHARITY ADJUSTMENT, IF ANY, AND THE COLLECTION PROCESS WILL CONTINUE IN THE NORMAL PROCESS.
PART VI, LINE 2:	IN 2020, THE HOSPITAL PARTICIPATED IN A COLLABORATIVE PROCESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF THE KING COUNTY HOSPITALS FOR A HEALTHIER COMMUNITY (HHC). HHC IS A COLLABORATIVE OF ALL 11 HOSPITALS AND HEALTH SYSTEMS IN KING COUNTY AND PUBLIC HEALTH-SEATTLE & KING COUNTY. THE HHC'S VISION IS TO PARTICIPATE IN A COLLABORATIVE APPROACH THAT IDENTIFIES COMMUNITY NEEDS, ASSETS, RESOURCES, AND STRATEGIES TOWARD ASSURING BETTER HEALTH AND HEALTH EQUITY FOR ALL KING COUNTY RESIDENTS. THIS SHARED APPROACH AVOIDS DUPLICATION AND FOCUSES AVAILABLE RESOURCES ON A COMMUNITY'S MOST IMPORTANT HEALTH NEEDS. HHC RECOGNIZES THAT PARTNERSHIPS BETWEEN HOSPITALS, PUBLIC HEALTH, COMMUNITY ORGANIZATIONS AND COMMUNITIES ARE KEY TO SUCCESSFUL STRATEGIES TO ADDRESS COMMON HEALTH NEEDS.DATA ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR THE MEDICAL CENTER'S PRIMARY SERVICE AREA, GIVEN THE AVAILABILITY OF THE DATA. IN SOME CASES, DATA WERE ONLY AVAILABLE AT THE COUNTY LEVEL.SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED AND ANALYZED THROUGH A REVIEW OF THE SECONDARY HEALTH DATA PRIOR TO THE INTERVIEWS. HEALTH NEEDS WERE IDENTIFIED USING THE SIZE OF THE PROBLEM (RELATIVE PORTION OF POPULATION AFFLICTED BY THE PROBLEM) AND THE SERIOUSNESS OF THE PROBLEM (IMPACT AT INDIVIDUAL, FAMILY, AND COMMUNITY LEVELS). TO DETERMINE SIZE OR SERIOUSNESS OF THE PROBLEM, THE HEALTH NEED INDICATORS WERE MEASURED AGAINST BENCHMARK DATA (COUNTY RATES, STATE RATES AND/OR HEALTHY PEOPLE 2021 OBJECTIVES). INDICATORS RELATED TO THE HEALTH NEEDS THAT PERFORMED POORLY AGAINST ONE OR MORE OF THESE BENCHMARKS MET THE CRITERION TO BE CONSIDERED. SECONDARY DATA WAS COLLECTED FROM A VARIETY OF LOCAL, COUNTY AND STATE SOURCES TO PRESENT A COMMUNITY PROFILE, BIRTH INDICATORS, LEADING CAUSES OF DEATH, ACCESS TO CARE, CHRONIC DISEASE, COMMUNICABLE DISEASE, HEALTH BEHAVIORS, SOCIAL ISSUES AND SCHOOL AND STUDENT CHARACTERISTICS. WHEN AVAILABLE, THESE DATA SETS WERE PRESENTED IN THE CONTEXT OF KING COUNTY AND WASHINGTON, FRAMING THE SCOPE OF AN ISSUE AS IT RELATES TO THE BROADER COMMUNITY.IN ADDITION, THE HOSPITAL CONDUCTED TARGETED INTERVIEWS TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL. THE REPORT INCLUDES BENCHMARK COMPARISON DATA, COMPARING THE HOSPITAL COMMUNITY DATA FINDINGS WITH HEALTH PEOPLE 2021 OBJECTIVES.
PART VI, LINE 3:	INFORMATION ABOUT ASSISTANCE PROGRAMS STARTS AT THE POINT OF REGISTRATION. PLACARDS DESCRIBING THE FINANCIAL ASSISTANCE PROGRAMS ARE AT ALL ADMITTING REGISTRATION DESKS. FINANCIAL ASSISTANCE CAN TAKE THE FORM OF ASSISTANCE IN QUALIFYING FOR MEDICAID, CHARITY, OR PROMPT PAY DISCOUNTS. FINANCIAL COUNSELORS ARE AVAILABLE TO DISCUSS THE FINANCIAL ARRANGEMENTS FOR ALL PATIENTS AND THEY DISCUSS THE FINANCIAL ASSISTANCE PROGRAM. THE FINANCIAL COUNSELORS WILL ALSO ASSIST PATIENTS IN COMPLETING THE HOSPITAL'S CHARITY CARE APPLICATION IF THE PATIENT BRINGS IN INFORMATION AND NEEDS HELP COMPLETING THE APPLICATION. THE HOSPITAL ENGAGES AN OUTSIDE COMPANY TO ASSIST PATIENTS WITH APPLYING FOR MEDICAID. GENERAL INFORMATION ABOUT THE ASSISTANCE PROGRAMS IS THEN INCLUDED AS PART OF EACH PATIENT STATEMENT THAT IS SENT TO A PATIENT AND INCLUDES THE PHONE NUMBER OF THE PATIENT FINANCIAL SERVICES DEPARTMENT TO CALL FOR ASSISTANCE. IN ADDITION, AS PART OF THE ACCOUNT FOLLOW UP, PATIENT FINANCIAL SERVICE REPRESENTATIVES WILL CALL PATIENTS AFTER THEIR SECOND STATEMENT AND WILL DISCUSS PATIENT FINANCIAL ASSISTANCE AS PART OF THE CALL. OVERLAKE'S CHARITY CARE POLICY IS POSTED ON THE WASHINGTON STATE DEPARTMENT OF HEALTH'S WEBSITE AND ON THE HOSPITAL'S WEBSITE.
PART VI, LINE 4:	THE SERVICE AREA FOR OVERLAKE IS DIVIDED INTO TWO MARKETS - LOCAL AND OUTLYING - WITH THE LOCAL MARKET DIVIDED INTO FIVE SERVICE AREAS (BELLEVUE, EAST, ISSAQUAH/SAMMAMISH, REDMOND/KIRKLAND, AND SW) AND THE OUTLYING MARKET DIVIDED INTO TWO SERVICE AREAS (NORTH AND SOUTH). THE POPULATION OF THE OVERLAKE SERVICE AREA IS 934,576. CHILDREN AND YOUTH, AGES 0-19, MAKE UP ALMOST ONE-FOURTH 25% OF THE POPULATION OF THE SERVICE AREA; 4.5% ARE 20-24 YEARS OF AGE, 30.5% ARE 25-44, 27.3% ARE 45-64, AND 12.3% OF THE POPULATION ARE SENIORS, 65 YEARS OF AGE AND OLDER. THE AREA HAS HIGHER RATES OF CHILDREN UNDER AGE 18 AND FEWER SENIORS WHEN COMPARED TO THE COUNTY AND THE STATE. THE MAJORITY RACE/ETHNICITY IN THE SERVICE AREA IS WHITE/CAUCASIANS 63.9% WHILE ASIANS MAKE UP 20.9% OF THE POPULATION, AND HISPANICS OR LATINOS ARE 7.2%.POVERTY THRESHOLDS ARE USED FOR CALCULATING ALL OFFICIAL POVERTY POPULATION STATISTICS AND ARE UPDATED EVERY THREE YEARS BY THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. THE NEXT UPDATE WILL BE IN 2024. IN THE OVERLAKE SERVICE AREA, 5.8% OF THE POPULATION WAS LIVING AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) AND 13.0% WERE CONSIDERED LOW-INCOME (LIVING AT OR BELOW 200% FPL). THESE RATES ARE BETTER THAN COUNTY AND STATE. THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA IS $113,691. THIS IS HIGHER MEDIAN INCOME THAN IN THE COUNTY ($89,418) OR STATE ($70,116).
PART VI, LINE 5:	THE HOSPITAL STAFF PARTICIPATES IN THE COUNTY WIDE DISASTER PREPAREDNESS GROUP AND IS THE BACK UP TO HARBORVIEW MEDICAL CENTER. THE HOSPITAL HAS AN OPEN MEDICAL STAFF MODEL. THE HOSPITAL OPERATES AN ACTIVE SCREENING PROGRAM IN WHICH WE OFFER FREE HEALTH SCREENINGS AT LEAST FOUR TIMES ANNUALLY AT COMMUNITY EVENTS. THE LARGEST ONE IS THE ANNUAL OVERLAKE EASTSIDE VITALITY COMMUNITY HEALTH FAIR IN WHICH WE PROVIDE OVER 2,000 FREE SCREENINGS INCLUDING CHOLESTEROL, STROKE RISK, DIABETES, AND SKIN CANCER. SCREENING RESULTS AND FREE COUNSELING ARE PROVIDED AT THE EVENTS. THOSE WHO NEED TO SEE A PHYSICIAN ARE GIVEN A LIST OF PROVIDERS, INCLUDING COMMUNITY MEDICAL CLINICS.

Schedule H (Form 990) 2021

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number
91-0652651

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) OVERLAKE HOSPITAL FOUNDATION 1035 116TH AVE NE BELLEVUE,WA98004	91-1050325	501(C)(3)	2,438,892	SUPPORT OPERATION
(2) AMERICAN HEART ASSOCIATION PO BOX 4002030 DES MOINES,IA503402030	13-5613797	501(C)(3)	25,000	SPONSOR
(3) ATTAIN HOUSING 125 STATE ST S KIRKLAND,WA98033	91-1481848	501(C)(3)	15,000	SPONSOR
(4) BELLEVUE CHAMBER 330 112TH AVENUE NE BELLEVUE,WA98004	91-0533602	501(C)(6)	23,000	SPONSOR
(5) BELLEVUE COLLEGE FOUNDATION 3000 LANDERHOLM CIRCLE SE A101 BELLEVUE,WA980076484	91-1051671	501(C)(3)	10,000	SPONSOR
(6) BELLEVUE SCHOOL FOUNDATION PO BOX 40644 BELLEVUE,WA98005	91-1080997	501(C)(3)	25,000	SPONSOR
(7) BELLEVUE LIFESPRING 302 BELLEVUE SQUARE BELLEVUE,WA98004	91-0658331	501(C)(3)	10,000	SPONSOR
(8) BLOODWORKS NORTHWEST 921 TERRY AVENUE SEATTLE,WA98104	91-1019655	501(C)(3)	20,000	SPONSOR
(9) CANCER LIFELINE 6522 FREMONT AVENUE N SEATTLE,WA98103	91-6182951	501(C)(3)	12,500	SPONSOR
(10) CONGREGATION FOR THE HOMELESS 515 116TH AVENUE NE SUITE 150 BELLEVUE,WA98004	45-3932748	501(C)(3)	15,000	SPONSOR
(11) CHINESE INFORMATION & SERVICE CENTER 611 S LANE ST SEATTLE,WA98104	23-7438529	501(C)(3)	7,500	SPONSOR
(12) ESSEX COMMUNITY OUTREACH CORP 7683 SE 27TH ST SUITE 411 MERCER ISLAND,WA98040	22-3628802	501(C)(3)	8,000	SPONSOR
(13) HOPELINK 8990 154TH AVENUE NE REDMOND,WA98052	91-0982116	501(C)(3)	30,000	SPONSOR
(14) LAKE WASHINGTON SCHOOLS FOUNDATION PO BOX 83 REDMOND,WA98073	55-0891792	501(C)(3)	15,000	SPONSOR
(15) MARY'S PLACE PO BOX 1711 SEATTLE,WA98111	27-2087950	501(C)(3)	10,000	SPONSOR
(16) MERCER ISLAND SCHOOLS FOUNDATION 4160 86TH AVENUE SE MERCER ISLAND,WA98040	91-1143444	501(C)(3)	12,900	SPONSOR
(17) NAMI EASTSIDE 16307 NE 83RD ST SUITE 203 REDMOND,WA98052	91-2106510	501(C)(3)	25,000	SPONSOR
(18) NAMI WASHINGTON 1107 NE 45TH SUITE 340 SEATTLE,WA98105	91-1689067	501(C)(3)	7,500	SPONSOR
(19) ONE REDMOND 8383 158TH AVENUE NE SUITE 225 REDMOND,WA98052	46-0535220	501(C)(3)	15,000	SPONSOR
(20) THE SOPHIA WAY 1100 BELLEVUE WAY NE 8A-110 BELLEVUE,WA98004	45-4084539	501(C)(3)	10,000	SPONSOR
(21) TOGETHER CENTER 16307 NE 83RD ST SUITE 104 REDMOND,WA98052	91-1508791	501(C)(3)	10,000	SPONSOR
(22) WASHINGTON POISON CENTER 155 NE 100TH ST SUITE 100 SEATTLE,WA98125	94-3214597	501(C)(3)	10,000	SPONSOR
(23) SEATTLE CHILDREN'S FOUNDATION PO BOX 5371 818-F SEATTLE,WA98145	91-1156519	501(C)(3)	10,000	SPONSOR
(24) YOUTH EASTSIDE SERVICES 999 164TH AVE NE BELLEVUE,WA98008	91-0849093	501(C)(3)	10,000	SPONSOR
(25) ZERO PROSTATE CANCER PO BOX 320812 ALEXANDRIA,VA22320	59-3400922	501(C)(3)	7,500	SPONSOR

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	OVERLAKE HOSPITAL MEDICAL CENTER PERFORMS THE RECORD KEEPING FOR OVERLAKE HOSPITAL FOUNDATION AND MONITORS ITS OPERATING EXPENSES AS PART OF THE MONTHLY FINANCIAL REVIEW PROCESS. THE GRANTS ARE REIMBURSEMENT FOR EXPENSES ALREADY INCURRED. GRANTS TO SPONSOR EVENTS OF NON PROFIT ORGANIZATIONS ARE NOT MONITORED BEYOND VERIFYING THAT THE EVENT OCCURRED.

Schedule I (Form 990) 2021

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1J MICHAEL MARSH PRESIDENT & CEO	(i) (ii)	856,487 ------------- 0	340,548 ------------- 0	117,334 ------------- 0	122,561 ------------- 0	18,245 ------------- 0	1,455,175 ------------- 0	97,060 ------------- 0
2ASIF ALI KHAN MD NEUROSURGEON	(i) (ii)	995,814 ------------- 0	25,743 ------------- 0	37,844 ------------- 0	14,500 ------------- 0	19,975 ------------- 0	1,093,876 ------------- 0	0 ------------- 0
3DEREK M RODRIGUES MD CARDIOLOGIST	(i) (ii)	885,351 ------------- 0	54,836 ------------- 0	73,655 ------------- 0	20,300 ------------- 0	19,073 ------------- 0	1,053,215 ------------- 0	0 ------------- 0
4AMITOZ SINGH MANHAS MD NEUROSURGEON	(i) (ii)	830,862 ------------- 0	58,345 ------------- 0	26,743 ------------- 0	14,500 ------------- 0	19,975 ------------- 0	950,425 ------------- 0	0 ------------- 0
5DAVID W NELSON MD CARDIOLOGIST	(i) (ii)	796,464 ------------- 0	59,693 ------------- 0	35,326 ------------- 0	20,300 ------------- 0	19,073 ------------- 0	930,856 ------------- 0	0 ------------- 0
6ROBERT S BINFORD MD CARDIOLOGIST	(i) (ii)	731,461 ------------- 0	59,693 ------------- 0	13,951 ------------- 0	20,300 ------------- 0	19,975 ------------- 0	845,380 ------------- 0	0 ------------- 0
7THOMAS A DEBORD COO	(i) (ii)	507,230 ------------- 0	173,951 ------------- 0	57,347 ------------- 0	80,582 ------------- 0	12,348 ------------- 0	831,458 ------------- 0	23,344 ------------- 0
8DAVID A KNOEPFLER FORMER KEY EMPLOYEE	(i) (ii)	498,546 ------------- 0	174,271 ------------- 0	63,806 ------------- 0	77,816 ------------- 0	12,348 ------------- 0	826,787 ------------- 0	31,744 ------------- 0
9KELAN R KOENIG MD OMC PHYSICIAN EXECUTIVE	(i) (ii)	442,680 ------------- 0	155,180 ------------- 0	20,934 ------------- 0	82,753 ------------- 0	19,146 ------------- 0	720,693 ------------- 0	0 ------------- 0
10ANDREW J TOKAR CFO	(i) (ii)	428,308 ------------- 0	143,248 ------------- 0	20,574 ------------- 0	77,376 ------------- 0	7,638 ------------- 0	677,144 ------------- 0	0 ------------- 0
11MICHELLE CURRY VP/CHIEF NURSING OFFICER	(i) (ii)	292,518 ------------- 0	80,478 ------------- 0	1,434 ------------- 0	55,570 ------------- 0	7,638 ------------- 0	437,638 ------------- 0	0 ------------- 0
12VALERIE CHRUSCIEL OMC COO	(i) (ii)	282,517 ------------- 0	76,758 ------------- 0	1,434 ------------- 0	54,980 ------------- 0	12,348 ------------- 0	428,037 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 7

INCENTIVES IN 2021 WERE PAID TO J. MICHAEL MARSH, THOMAS A. DEBORD, ANDREW J. TOKAR, KELAN R. KOENIG, VALERIE CHRUSCIEL, MICHELLE CURRY, AND DAVID A. KNOEPFLER. THE INCENTIVES ARE AWARDED BASED ON PRODUCTIVITY AND MEETING CERTAIN INDIVIDUAL QUALITY GOALS.

PART I, LINE 4B:

THOMAS A. DEBORD, J. MICHAEL MARSH AND ANDREW J. TOKAR 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. THE FOLLOWING AMOUNTS REFLECT 2021 DEFERRALS: THOMAS A. DEBORD ($13,172), DAVID A. KNOEPFLER ($19,500), J. MICHAEL MARSH ($19,500) AND ANDREW J. TOKAR ($19,500). THE FOLLOWING AMOUNTS FROM THE CAPITAL ACCUMULATION ACCOUNT WERE PAID IN 2021: THOMAS A. DEBORD ($23,344), DAVID A. KNOEPFLER ($31,744) AND J. MICHAEL MARSH ($97,060). THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR FORMS 990. J. MICHAEL MARSH, THOMAS A. DEBORD AND DAVID A. KNOEPFLER RECEIVED REDEMPTION OF CREDITS IN THE CAPITAL ACCUMULATION ACCOUNT THAT HAD BECOME VESTED.

Schedule J (Form 990) 2021

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number
91-0652651

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	WA HEALTH CARE FACILITIES	91-1108929	93978HKJ3	08-06-2014	58,116,440	REFUND PRIOR ISSUE-6/8/05		X		X		X
B	WA HEALTH CARE FACILITIES	91-1108929	93978HUA1	12-21-2017	249,215,382	CONSTRUCT, RENOVATE FACILITY, AND REFUND PRIOR ISSUE (4/14/10)		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	13,055,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	58,151,860		256,198,001
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............			19,810
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	825,678		1,653,471
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............	60,425
10 Capital expenditures from proceeds .............			152,697,992
11 Other spent proceeds .............	57,265,757		101,826,728
12 Other unspent proceeds .............
13 Year of substantial completion .............	2008		2021
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........		X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........	X		X
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.140 %		0.070 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %
6 Total of lines 4 and 5 .............	0.140 %		0.070 %
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............	X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	2.530 %		3.190 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X	X
b Exception to rebate? ........		X		X
c No rebate due? .........	X			X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: WA HEALTH CARE FACILITIES DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2015
SCHEDULE K, PART II, LINE 3:	THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO THE INVESTMENT EARNINGS.

Schedule K (Form 990) 2021

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Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) DARSHANA SHANBHAG	FAMILY MEMBER OF TRUSTEE DILIP WAGLE	134,700	DARSHANA SHANBHAG IS EMPLOYED BY OVERLAKE HOSPITAL MEDICAL CENTER.		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990) 2021

Additional Data

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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.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Return Reference	Explanation
FORM 990, PART I, LINE 6:	VOLUNTEERS PROVIDED 14,223 HOURS OF SERVICE TO OVERLAKE HOSPITAL MEDICAL CENTER DURING THE YEAR. VOLUNTEERS PROVIDE ASSISTANCE FOR PATIENTS AND GUESTS AT POINT OF ENTRY WITH INFORMATION, WAY-FINDING, AND TRANSPORTATION SERVICES. IN THE NURSING UNITS, VOLUNTEERS HELP ANSWER CALL LIGHTS AND PROVIDE COMFORT TO SUPPORT AND FACILITATE THE PHYSICAL, EMOTIONAL, MENTAL AND SPIRITUAL HEALTH AND SELF-HEALING OF THE PATIENT. INCLUDED IN THE TOTAL VOLUNTEERS ARE 23 BOARD MEMBERS THAT VOLUNTEERED THEIR TIME AS BOARD MEMBERS DURING THE YEAR.
FORM 990, PART III, LINE 4A:	HOSPITAL SERVICES: OVERLAKE HOSPITAL MEDICAL CENTER IS A NONPROFIT, INDEPENDENTLY OPERATED REGIONAL CENTER SERVING THE EASTERN PUGET SOUND REGION WITH MEDICAL FACILITIES IN BELLEVUE, ISSAQUAH, KIRKLAND, REDMOND, SAMMAMISH, AND NEWCASTLE. FOUNDED IN 1953, TODAY OVERLAKE HOSPITAL IS A REGIONAL LEADER IN HEALTH CARE, PROVIDING ADVANCED MEDICAL SERVICES IN THE AREAS OF CARDIAC CARE, GENERAL AND SPECIALTY SURGERY, WOMEN'S SERVICES, CANCER CARE AND EMERGENCY SERVICES. THE HOSPITAL ALSO HAS A NETWORK OF NEIGHBORHOOD CLINICS IN ITS PRIMARY SERVICE AREA. THERE WERE 14,468 PATIENTS ADMITTED FOR INPATIENT MEDICAL CARE FOR A TOTAL OF 70,050 PATIENT DAYS. THERE WERE 255,795 OUTPATIENT VISITS OF WHICH 55,239 WERE FOR EMERGENCY CARE VISITS. THE HOSPITAL DELIVERED 3,640 BABIES. OVERLAKE MEDICAL CLINICS PROVIDED 412,124 PATIENT VISITS. OVERLAKE HOSPITAL DEMONSTRATED A COMMITMENT TO IMPROVING THE HEALTH OF THE COMMUNITY BY SUPPORTING MANY HEALTH-RELATED EVENTS, PROGRAMS, CLINICAL RESEARCH AND VARIOUS CONTRIBUTIONS THROUGHOUT THE YEAR THAT HAD A DIRECT BENEFIT TO THE COMMUNITY. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES. OVERLAKE HOSPITAL PROVIDED CARE TO 6,695 PATIENTS WHO WERE UNINSURED OR UNDER INSURED AT AN ESTIMATED COST OF $5,545,000. THE HOSPITAL PROVIDED CARE TO MEDICAID PATIENTS AT RATES BELOW THE COST OF PROVIDING SERVICES. THE PAYMENTS WERE LESS THAN COST BY $33,493,000. IN KEEPING WITH THE HOSPITAL'S SPIRIT OF GIVING BACK TO THE COMMUNITY, IT PROVIDED A TOTAL OF $8,637,000 OF COMMUNITY BENEFIT SERVICE ACTIVITIES. AS THE HEALTH CARE NEEDS OF OUR COMMUNITY INCREASE AND GROW MORE COMPLEX, OVERLAKE HAS STRENGTHENED ITS COMMITMENT TO PROVIDING THE MOST ADVANCED TREATMENT AND TECHNOLOGY ALONGSIDE COMPASSIONATE CARE EVERY DAY. WITH HEALTH CARE PROMINENT IN THE NATIONAL DEBATE, OVERLAKE MEDICAL CENTER IS GIVING EASTSIDE RESIDENTS AN OPPORTUNITY FOR A WIDE VARIETY OF FREE HEALTH SCREENINGS WHERE THE BARRIERS OF BOTH COST AND LANGUAGE ARE REMOVED. THE SCREENINGS ARE FREE AND DO NOT REQUIRE PATIENTS TO HAVE HEALTH INSURANCE. THE FREE SCREENINGS INCLUDE CHOLESTEROL, BLOOD PRESSURE, BODY MASS INDEX, CARDIAC AND DIABETES RISK ASSESSMENTS. CONSULTATIONS WITH A HEALTH CARE PROVIDER WILL ALLOW PATIENTS TO UNDERSTAND WHAT SCREENING RESULTS MEAN. FURTHERMORE, NOT WANTING LANGUAGE TO BE A BARRIER TO PATIENTS NOT FLUENT IN ENGLISH, OVERLAKE OFFERS INTERPRETERS IN MULTIPLE LANGUAGES INCLUDING MANDARIN, CANTONESE, HINDI, SPANISH, AND RUSSIAN. IT IS PART OF OVERLAKE'S MISSION TO BRING HEALTH CARE OUT INTO THE COMMUNITY, TO MAKE IT ACCESSIBLE TO ALL PEOPLE AND THESE COMPLIMENTARY SCREENINGS HELP US FULFILL OUR MISSION IN A MEANINGFUL WAY. THE FUTURE IS NOW: PROJECT FUTURECARE, OUR $250 MILLION CAMPUS RENEWAL, SUPPORTED BY A $50 MILLION FUNDRAISING CAMPAIGN, IS WELL ON ITS WAY TO TRANSFORMING OVERLAKE. THE PROJECT REPLACED AN AGING BUILDING WITH A STATE-OF-THE-ART FACILITY THAT EXTENDS AND SUPPORT OUR WORLD-CLASS CARE. NEW OPERATING ROOMS INCREASE THE NUMBER OF HEART PATIENTS WE CAN CARE FOR. THE CHILDBIRTH CENTER IN THE NEW BUILDING WILL INCLUDE BEAUTIFUL ROOMS WITH SPACE TO WELCOME FAMILY MEMBERS AND A HOST OF UPGRADED FEATURES. AN EXPANDED MENTAL HEALTH UNIT MAKES CARE MORE ACCESSIBLE FOR PATIENTS WHO COME TO US WITH MENTAL HEALTH AS WELL AS MEDICAL CHALLENGES. IN 2018, SUPPORT FROM THE COMMUNITY HELPED THE OVERLAKE NEUROSCIENCE INSTITUTE OPEN THE FIRST AND ONLY EPILEPSY CLINIC ON THE EASTSIDE. PATIENTS WITH SEIZURE DISORDERS CAN NOW RECEIVE DIAGNOSTIC AND TREATMENT SERVICES CLOSE TO HOME. ACHIEVEMENT AWARDS RECEIVED IN 2021: 1. OVERLAKE HOSPITAL RANKED AS BEST HOSPITAL TO HAVE A BABY BY U.S. NEWS & WORLD REPORT. U.S. NEWS & WORLD REPORT IN DECEMBER 2021 RELEASED ITS INAUGURAL LIST OF THE BEST U.S. HOSPITALS FOR MATERNITY. OVERLAKE HOSPITAL IS THE ONLY HOSPITAL IN WASHINGTON STATE LISTED AMONG THE "BEST" FOR MATERNITY CARE FOR UNCOMPLICATED PREGNANCIES. 2. OVERLAKE MEDICAL CENTER & CLINICS HAS ONCE AGAIN RECEIVED AN "A" LEAPFROG HOSPITAL SAFETY GRAND FOR FALL 2021. THIS NATIONAL DISTINCTION RECOGNIZES OVERLAKE'S ACHIEVEMENT IN PROTECTING PATIENTS FROM HARM AND ERROR IN THE HOSPITAL. THIS IS THE THIRD "A" GRADE IN A ROW FOR OVERLAKE HOSPITAL. 3. OVERLAKE MEDICAL CENTER & CLINICS IS A RECIPIENT OF THE HEALTHGRADES 2021 GYNECOLOGIC SURGERY EXCELLENCE AWARD. THIS AWARD PLACES OVERLAKE MEDICAL CENTER AMONG THE TOP 5% OF ALL HOSPITALS EVALUATED FOR PROVIDING OUTSTANDING QUALITY OUTCOMES IN GYNECOLOGIC SURGERY. OVERLAKE IS THE ONLY HOSPITAL IN THE STATE OF WASHINGTON TO ACHIEVE THIS HONOR IN 2021. 4. OVERLAKE MEDICAL CENTER RECEIVED THREE AWARDS FROM THE GET WITH THE GUIDELINES PROGRAM FROM THE AMERICAN HEART ASSOCIATION: 2021 GET WITH THE GUIDELINES HEART FAILURE: SILVER PLUS QUALITY ACHIEVEMENT AWARD BRONZE QUALITY ACHIEVEMENT AWARD WITH HONOR ROLL 2021 GET WITH THE GUIDELINES STROKE: GOLD PLUS QUALITY ACHIEVEMENT AWARD THE MISSION: LIFELINE AND GET WITH THE GUIDELINES PROGRAMS HELP PUT PROVEN KNOWLEDGE AND GUIDELINES TO WORK ON A DAILY BASIS TO IMPROVE OUTCOMES FOR CARDIOVASCULAR PATIENTS.
FORM 990, PART VI, SECTION A, LINE 7A	OVERLAKE HOSPITAL ASSOCIATION HAS THE RIGHT TO APPOINT AND REMOVE OVERLAKE HOSPITAL MEDICAL CENTER'S TRUSTEES.
FORM 990, PART VI, SECTION A, LINE 7B	OVERLAKE HOSPITAL ASSOCIATION MUST APPROVE: (A) ANY SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (B) ANY INCREASED INDEBTEDNESS EXCEEDING FIVE PERCENT OF THE GROSS PATIENT SERVICE REVENUE 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 PRESIDENT & CEO, CFO, CHIEF HUMAN RESOURCES AND COMPLIANCE OFFICER, AND THE OVERLAKE HOSPITAL MEDICAL CENTER AUDIT AND COMPLIANCE COMMITTEE. THE 990 IS SENT TO THE OVERLAKE HOSPITAL MEDICAL CENTER 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 ORGANIZATIONS 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 INTEREST OR OTHER RELATIONSHIPS WITH ANY ORGANIZATIONS THAT HAS, OR CAN 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 CHAIR, COMMITTEE CHAIRS, AND 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 15	OVERLAKE'S POLICY AND PROCESS FOR EXECUTIVE COMPENSATION IS FULLY DOCUMENTED IN THE "EXECUTIVE COMPENSATION ADMINISTRATION AND COMPLIANCE MANUAL" WHICH WAS LAST UPDATED IN 2017. THIS MANUAL DETAILS THE CHARTER OF THE COMPENSATION COMMITTEE OF THE BOARD, THE COMPENSATION PHILOSOPHY AND HOW SALARY INCREASES, INCENTIVES AND 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 CEO, COO AND OTHER EXECUTIVES ARE DISCUSSED, DELIBERATED AND VOTED ON BY THE COMPENSATION COMMITTEE AND DOCUMENTED IN THE MINUTES OF THE MEETING. THE COMPENSATION AND INCENTIVE PAYMENT OF THE CEO IS REVIEWED AND APPROVED BY THE FULL BOARD.
FORM 990, PART VI, SECTION C, LINE 19	OVERLAKE HOSPITAL MAKES ITS DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE THROUGH THE HOSPITAL'S ADMINISTRATION OFFICE. THE OVERLAKE HOSPITAL ASSOCIATION CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE ON THE OVERLAKE MEDICAL CENTER'S WEBSITE.
FORM 990, PART IX, LINE 11G	OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 82,063,670. MANAGEMENT AND GENERAL EXPENSES 17,360,220. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 99,423,890.
FORM 990, PART XI, LINE 9:	EQUITY CONTRIBUTION TO RELATED ORGANIZATION -889,800. INVESTMENT IN RELATED ORGANIZATION -2,731,082.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

OVERLAKE HOSPITAL MEDICAL CENTER

Employer identification number

91-0652651

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) OVERLAKE MEDICAL CLINICS LLC 1035 116TH AVENUE NE BELLEVUE,WA98004 91-1932954	MEDICAL CLINICS	WA	93,543,388	48,771,266	OVERLAKE HOSPITAL MEDICAL CENTER
(2) OVERLAKE PROVIDER NETWORK LLC 1035 116TH AVENUE NE BELLEVUE,WA98004 47-4545130	CLINICALLY INTEGRATED NETWORK	WA	0	0	OVERLAKE HOSPITAL MEDICAL CENTER

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)OVERLAKE HOSPITAL FOUNDATION 1035 116TH AVE NE BELLEVUE,WA98004 91-1050325	FUNDRAISING	WA	501(C)(3)	7 - 509(A)(1)	OVERLAKE HOSPITAL MEDICAL CENTER	Yes
(2)OVERLAKE HOSPITAL AUXILIARIES 1035 116TH AVE NE BELLEVUE,WA98004 23-7297831	FUNDRAISING	WA	501(C)(3)	7 - 509(A)(1)	OVERLAKE HOSPITAL MEDICAL CENTER	Yes
(3)OVERLAKE HOSPITAL ASSOCIATION 1035 116TH AVE NE BELLEVUE,WA98004 91-1274134	PROVIDE SUPPORT	WA	501(C)(3)	12B - TYPE II SUPPOR	N/A	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) OVERLAKE SURGERY CENTER LLC 1135 116TH AVENUE NE 300 BELLEVUE,WA98004 91-1925618	SURGERY CENTER	WA	OVERLAKE HOSPITAL MEDICAL CENTER	RELATED	-546,570	975,554		No			No	81.160 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) OVERLAKE HOSPITAL FOUNDATION	B	2,438,892	CASH
(2) OVERLAKE HOSPITAL FOUNDATION	C	9,141,355	CASH
(3) OVERLAKE HOSPITAL FOUNDATION	N	139,596	CASH
(4) OVERLAKE HOSPITAL FOUNDATION	O	239,838	CASH
(5) OVERLAKE HOSPITAL ASSOCIATION	B	4,500,000	CASH
(6) OVERLAKE HOSPITAL ASSOCIATION	O	161,472	CASH
(7) OVERLAKE HOSPITAL ASSOCIATION	P	644,612	CASH
(8) OVERLAKE HOSPITAL ASSOCIATION	A	8,282,429	FMV
(9) OVERLAKE SURGERY CENTER LLC	D	950,000	CASH
(10) OVERLAKE SURGERY CENTER LLC	B	889,800	CASH

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE PURPOSE IS TO OPERATE A HOSPITAL FOR THE CARE OF PERSONS, TO PARTICIPATE IN EDUCATION, RESEARCH AND OTHER ACTIVITIES DESIGNED TO PROMOTE GENERAL HEALTH OF THE COMMUNITY. THE HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE CARE FOR EVERY LIFE WE TOUCH.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	20
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	3,367
6	Total number of volunteers (estimate if necessary) .............	6	136
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	928

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	22,279,637	18,628,819
9	Program service revenue (Part VIII, line 2g) .........	590,464,551	626,810,817
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	31,935,333	52,665,991
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,826,174	4,685,455
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	648,505,695	702,791,082
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,432,603	2,803,542
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	346,379,941	385,579,117
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	274,532,327	325,648,939
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	623,344,871	714,031,598
19	Revenue less expenses. Subtract line 18 from line 12.......	25,160,824	-11,240,516
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,137,955,919	1,021,060,160
21	Total liabilities (Part X, line 26).............	486,725,975	503,607,176
22	Net assets or fund balances. Subtract line 21 from line 20.....	651,229,944	517,452,984

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 561,345,646 including grants of $ ) (Revenue $ 626,715,064 )
	SEE SCHEDULE O.

4b	(Code: ) (Expenses $ 2,803,542 including grants of $ 2,803,542 ) (Revenue $ )
	OTHER GRANTS AND ALLOCATIONS: GRANTS TO OVERLAKE HOSPITAL FOUNDATION TO COVER EXPENSES AND GRANTS TO SUPPORT OTHER COMMUNITY NONPROFIT ORGANIZATIONS.

4c	(Code: ) (Expenses $ 3,421,785 including grants of $ ) (Revenue $ 95,753 )
	EDUCATION SERVICES:IN ADDITION TO THE EXCELLENT CARE WE PROVIDE OUR PATIENTS, THE HOSPITAL FIRMLY BELIEVES EDUCATION IS CRITICAL TO OVERALL WELLNESS. THE HOSPITAL REACHES OUT TO THE COMMUNITY TO ENGAGE AND EMPOWER ITS PATIENTS IN BECOMING EDUCATED HEALTHCARE CONSUMERS BY OFFERING FREE AND LOW-COST CLASSES FOR ALL AGE GROUPS. HEALTH EDUCATION IS AN IMPORTANT PART OF PREVENTATIVE CARE. THE EDUCATION PROGRAM PROVIDED 17,522 FAMILY CONTACT HOURS OFFERING CLASSES OF A WIDE RANGE OF HEALTH RELATED TOPICS INCLUDING WOMEN'S HEALTH, PRENATAL CARE, COPING SKILLS, DEALING WITH CANCER, POSITIVE PARENTING, SAFETY, ASTHMA, HEART DISEASE, DIABETES, LIVING WILLS, INCONTINENCE, WEIGHT LOSS, MAINTAINING BALANCE, BABYSITTING FOR TEENS, CPR AND HEALTHY LIFESTYLES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses567,570,973

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	9,421,364	0	829,320

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	13,641,355
e	Government grants (contributions)		1e	4,882,240

f	All other contributions, gifts, grants, and similar amounts not included above		1f	105,224

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		18,628,819

		Business Code
2a	NON GOVERNMENT PAYMENT	622110	393,366,632	393,366,632
b	MEDICARE/MEDICAID	622110	228,838,292	228,838,292
c	OTHER PROGRAM SERVICES	900099	5,620,446	5,620,446
d	EDUCATION SERVICES	611710	95,753	95,753
e	PROGRAM RELATED INV.	900099	-1,110,306	-1,110,306
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		626,810,817

3 Investment income (including dividends, interest, and othersimilar amounts) ......			6,942,391			6,942,391
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		504,128	6a
b	Less: rental expenses		0	6b
c	Rental income or (loss)		504,128	6c
d	Net rental income or (loss).......			504,128			504,128
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		715,729,981	7a
b	Less: cost or other basis and sales expenses	14,279	669,992,102	7b
c	Gain or (loss)	-14,279	45,737,879	7c
d	Net gain or (loss).........			45,723,600			45,723,600
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	147,862
b	Less: cost of goods sold ..		10b	34,881
c	Net income or (loss) from sales of inventory..			112,981			112,981
Business Code			Miscellaneous Revenue
11a	CAFETERIA/CATERING		722514	1,920,589			1,920,589
b	QUALITY INCENTIVES		900099	1,233,200			1,233,200
c	PURCHASE DISCOUNTS		900099	390,332			390,332
d	All other revenue ....			524,225			524,225
e	Total. Add lines 11a–11d ......			4,068,346
12	Total revenue. See instructions.....			702,791,082	626,810,817	0	57,351,446

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,803,542	2,803,542
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	3,444,155	1,891,443	1,552,712
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	134,700	134,700
7	Other salaries and wages........	309,161,477	264,429,912	44,731,565
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	15,204,129	12,846,468	2,357,661
9	Other employee benefits .......	37,110,490	30,400,440	6,710,050
10	Payroll taxes ...........	20,524,166	17,404,468	3,119,698
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,139,610	94,949	1,044,661
c	Accounting ...........	221,875		221,875
d	Lobbying ...........	26,508		26,508
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	606,256		606,256
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	99,423,890	82,063,670	17,360,220
12	Advertising and promotion ....	1,837,024	225	1,836,799
13	Office expenses .......	11,360,915	7,198,889	4,162,026
14	Information technology ......	14,667,503	1,166,706	13,500,797
15	Royalties ..
16	Occupancy ...........	23,925,188	14,126,948	9,798,240
17	Travel ............	194,559	155,011	39,548
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	820,109	532,250	287,859
20	Interest ...........	9,777,057	9,777,057
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	32,259,179	23,276,881	8,982,298
23	Insurance ...	11,126,362	2,556,752	8,569,610
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	94,495,792	95,475,992	-980,200
b	MEDICAID ASSESSMENT	13,572,848		13,572,848
c	B&O TAX	7,322,110	34	7,322,076
d	LICENSE & MEMBERSHIP	1,514,507	916,463	598,044
e	All other expenses	1,357,647	318,173	1,039,474
25	Total functional expenses. Add lines 1 through 24e	714,031,598	567,570,973	146,460,625	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			21,957,149	1	14,680,556
2	Savings and temporary cash investments .........			6,801,901	2	13,173,629
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			86,626,837	4	109,313,618
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			13,513,805	8	14,294,365
9	Prepaid expenses and deferred charges ......			11,059,309	9	12,783,700
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	820,680,509
b	Less: accumulated depreciation	10b	395,023,716	404,335,288	10c	425,656,793
11	Investments—publicly traded securities .			536,357,557	11	378,789,916
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			2,621,130	13	1,714,899
14	Intangible assets ...............			3,389,871	14	2,118,405
15	Other assets. See Part IV, line 11 ...........			51,293,072	15	48,534,279
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,137,955,919	16	1,021,060,160

17	Accounts payable and accrued expenses .....	109,067,457	17	118,172,721
18	Grants payable ...		18
19	Deferred revenue .........	33,397,993	19	13,165,149
20	Tax-exempt bond liabilities .........	286,218,589	20	282,985,533
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	35,000,000
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	58,041,936	25	54,283,773
26	Total liabilities. Add lines 17 through 25..	486,725,975	26	503,607,176

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	651,229,944	27	517,452,984
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	651,229,944	32	517,452,984
33	Total liabilities and net assets/fund balances ........	1,137,955,919	33	1,021,060,160