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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.
Graphic Arrow Attach to Form 990.
Graphic Arrow 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 FOUNDATION
 
Employer identification number
91-1050325
Part I
General Information on Grants and Assistance
1
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? ........................
2
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 (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) OVERLAKE HOSPITAL MEDICAL CENTER
1035 116TH AVENUE NE
BELLEVUE,WA98004 		91-0652651 501(C)(3) 9,141,355 0     SUPPORT OVERLAKE HOSPITAL
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021
Page 2

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 FOUNDATION STAFF NOTIFIES THE OVERLAKE HOSPITAL MEDICAL CENTER ACCOUNTING STAFF WHEN THERE IS A SPECIFIC GRANT. IF THE GRANT IS FOR OPERATIONAL EXPENSES THAT THE HOSPITAL DOES NOT INCUR IN THE NORMAL COURSE OF BUSINESS, THE APPROPRIATE DEPARTMENT IN THE HOSPITAL IS CONTACTED TO DEVELOP PLANS AND TIMING FOR USING THE FUNDS AS DESIGNATED. IF THE GRANT IS FOR CAPITAL, THE ACCOUNTING STAFF WILL MONITOR WHEN THE CAPITAL HAS BEEN PURCHASED AND RELEASE THE GRANT FROM RESTRICTION. WHEN THE DEPARTMENT MAKES THE EXPENDITURE, ACCOUNTING IS NOTIFIED, AND THE RESTRICTION OF THE GRANT IS RELEASED.
Schedule I (Form 990) 2021



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