2023-05-15T17:43:10-05:00 2022-06-30 910189318 MOSS ADAMS LLP 999 THIRD AVENUE SUITE 2800 SEATTLE WA 98104 990 2021-07-01 910593488 PROVAIL PROV 2063637303 12550 AURORA AVE N SEATTLE WA 98133 MICHAEL J HATZENBELER CEO 2063637303 2023-05-15 1 MICHAEL HATZENBELER 999009999 EMINA O CRESSWELL CPA P01217304 2063026500 2023-05-15 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z MICHAEL J HATZENBELER 12550 AURORA AVE N SEATTLE WA 98133 24135026 0 X WWW.PROVAIL.ORG X 1942 WA PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 16 16 544 50 1145 145 20221486 23184179 725692 899029 243 168 -26509 -85202 20920912 23998174 0 0 0 0 17411076 18424796 14533 0 123558 1945878 3634668 19371487 22059464 1549425 1938710 17228128 17379385 8844224 7369411 8383904 10009974 PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 0 0 12627104 833471 COMMUNITY LIVING SERVICES - PROVIDES SUPPORTED LIVING SERVICES TO ADULTS WITH SEVERE DEVELOPMENTAL DISABILITIES. WE PROVIDE 24-HOUR SUPPORT, INSTRUCTION, PERSONAL CARE, AND NURSING SERVICES IN ACCESSIBLE, COMMUNITY-BASED HOMES THROUGHOUT THE GREATER SEATTLE AREA. APPROXIMATELY 73 CLIENTS ARE SERVED. ADDITIONALLY, WE OPENED OUR BRAINSPACE BOARDING HOME FOR SURVIVORS OF TRAUMATIC BRAIN INJURY IN FEBRUARY 2017 WITH SPACE TO SERVE 12 BOARDERS WITH A CURRENT 75 BOARDER STATUS. 4291960 65558 SUPPORTED EMPLOYMENT AND VOCATIONAL SERVICES - WE WORK WITH INDIVIDUALS WITH DISABILITIES TO SECURE AND RETAIN COMPETITIVE EMPLOYMENT BY HELPING WITH THE PROCESS OF IDENTIFYING CAREER GOALS, MATCHING CANDIDATES TO POSITIONS, TRAINING AND ORIENTATION AND ONGOING SUPPORT WHERE NEEDED. APPROXIMATE CASELOAD IS 415 CLIENTS. 1435843 0 THERAPEUTIC AND ASSISTIVE TECHNOLOGY SERVICES - OUR SERVICES INCLUDE SPEECH THERAPY, OCCUPATIONAL THERAPY AND ASSISTIVE TECHNOLOGY. THESE SERVICES ENABLE CHILDREN AND ADULTS WITH DISABILITIES OR INJURIES TO MAXIMIZE THEIR PERFORMANCE AND PRODUCTIVITY AT HOME, WORK, SCHOOL, AND IN LEISURE ACTIVITIES. APPROXIMATELY 100 CLIENTS WERE SERVED THIS YEAR. 18354907 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 0 1 544 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 0 X STEPHEN ROSSI 2068261024 12550 AURORA AVE N SEATTLE WA 98133 DENISE KAJANOFF IMMEDIATE PAST CHAIR 1.00 1.00 X X 0 0 0 STEVE SUTER 2ND VICE CHAIR 1.00 1.00 X X 0 0 0 TERRIE DEIDESHEIMER CHAIR 1.00 1.00 X X 0 0 0 MIKE HUGHES TREASURER 1.00 1.00 X X 0 0 0 TERRI SUTTON 1ST VICE CHAIR 1.00 1.00 X X 0 0 0 DALE DEWITT SECRETARY 1.00 1.00 X X 0 0 0 JIM CHESEMORE DIRECTOR 1.00 X 0 0 0 DON BLACK DIRECTOR 1.00 X 0 0 0 WHITNEY KEYES DIRECTOR 1.00 X 0 0 0 ALESHA MORGAN MARTINEZ DIRECTOR 1.00 X 0 0 0 AMANDA VAN HOOK DIRECTOR 1.00 X 0 0 0 JIM MITCHELL DIRECTOR 1.00 X 0 0 0 ROLAND DEEX DIRECTOR 1.00 X 0 0 0 MICHAEL KUROMI DIRECTOR 1.00 X 0 0 0 ASHLEY STUDERUS DIRECTOR 1.00 X 0 0 0 BRANDON CHISOLM DIRECTOR 1.00 X 0 0 0 MICHAEL HATZENBELER CEO 40.00 1.00 X 183000 0 14000 BEN ROBINSON CFO 40.00 1.00 X 143000 0 0 326000 0 14000 2 0 1 0 0 192384 22656740 335055 11410 23184179 THERAPEUTIC CLINIC 621400 737439 737439 EMPLOYMENT SERVICES 561300 65558 65558 96032 96032 899029 168 168 51650 56964 -5314 -5314 1145 -6459 0 192384 79888 -79888 -79888 23998174 899029 1145 -86179 398228 371943 26285 15553134 14173645 1379489 1008306 947808 60498 1465128 1358527 106601 10743 10743 16316 16316 118927 118927 737359 104928 541217 91214 17795 332 12263 5200 485918 176247 309671 394264 46937 347327 391257 256587 134670 68990 67605 1385 2757 2757 1699 456 1243 18715 18715 268731 138675 130056 91788 91788 REPAIRS & JANITORIAL 152853 97719 55134 OPEN JOB LISTINGS 105116 1698 103040 378 FOOD & APPRECIATION 28203 23890 4238 75 BOARD EXPENSES 10210 10210 713027 555695 130641 26691 22059464 18354907 3580999 123558 7083543 7541939 62292 62323 1916788 1870646 186160 31476 9622742 1923893 7877700 7698849 87663 0 0 162264 13982 11888 17228128 17379385 1185185 1855498 131860 3173 5621064 5510740 1906115 0 8844224 7369411 X 8268816 9936877 115088 73097 8383904 10009974 17228128 17379385 1938710 -312640 0 X 0 0 0 X 12830097 15347756 18547491 20221486 23184179 90131009 12830097 15347756 18547491 20221486 23184179 90131009 90131009 70832 72788 75951 81456 51818 352845 12538 12118 5727 30383 17479 58622 23362 333 99796 90614033 0.99470 0.99690 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - LAUNDRY INCOME LEASE DEPOSIT REFUND OTHER RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3146359 3146359 5684448 1430847 4253601 297645 93158 204487 446243 399888 46355 48047 48047 7698849 GOLF TOURNAMENT 192384 192384 79888 192384 192384 79888 79888 -79888 X 0 1 X X 0 0 0 0 0 1 0 1 0 MICHAEL HATZENBELER CEO 183000 0 0 0 0 0 0 0 14000 0 197000 0 0 0 PART I, LINE 1A PROVAIL PAID THE ROTARY CLUB DUES FOR THE CEO, $1,820 PART I, LINE 1B THE ROTARY CLUB MEMBERSHIP WAS PART OF THE BOARD'S RECOMMENDED DEVELOPMENT PLAN FOR THE CEO. PART I, LINE 6 THE CEO BONUS WAS BASED ON SEVERAL FACTORS; ONE OF WHICH WAS FINANCIAL PERFORMANCE. PART I, LINE 7 THE CEO BONUS WAS PARTIALLY DEPENDENT ON THE NET INCOME OF THE ORGANIZATION. THE AMOUNT WAS DETERMINED BY A PREVIOUSLY AGREED UPON CALCULATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION GENERALLY PROVIDES A DRAFT COPY OF THE FORM 990 TO THE GOVERNING BOARD AND REQUESTS ANY QUESTIONS OR COMMENTS BE DIRECTED TO THE CFO. THE ORGANIZATION GENERALLY PROVIDES A DRAFT COPY OF THE FORM 990 TO THE MANAGEMENT OF THE ORGANIZATION AND REQUESTS ANY QUESTIONS OR COMMENTS BE DIRECTED TO THE CFO. THIS PROCESS DID NOT OCCUR FOR FY22. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS ASKED TO REVIEW AND SIGN THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS AND ALSO FILL OUT A QUESTIONNAIRE AS PART OF THE PREPARATION FOR THE 990 DEALING WITH INDEPENDENCE. WE HAVE HAD NO CONFLICTS TO DEAL WITH. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD UNDERTAKES THE EVALUATION AND COMPENSATION SETTING FOR THE CEO. THEY COMPLETED THE EVALUATION PORTION BY GETTING INPUT FROM THE BOARD OF DIRECTORS AND EMPLOYEES SUPERVISED BY THE CEO. THEY ALSO REVIEWED SALARIES AT COMPARABLE AGENCIES VIA A COMPENSATION SURVEY PERFORMED BY ARCHBRIGHT, AN INDEPENDENT ORGANIZATION. MINUTES OF THESE MEETINGS WERE KEPT. USING BOTH THE EVALUATION AND THE COMPARABLE SALARY INFORMATION THEY SET THE SALARY FOR THE CEO. WE HAVE NO OTHER EMPLOYEES WHO MEET THE DEFINITION OF KEY EMPLOYEE. EACH YEAR WE PULL SALARY INFORMATION FROM ARCHBRIGHT WHICH COMPILES COMPREHENSIVE NON-PROFIT AND FOR-PROFIT SALARY INFORMATION FROM HUNDREDS OF COMPANIES AND NON-PROFITS IN THE PACIFIC NORTHWEST AND WE USE THAT SALARY INFORMATION TO INFORM PAY INCREASES AND WAGE RANGES FOR ALL POSITIONS AT PROVAIL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PROVAIL - AFFILIATES KING & SNOHOMISH COUNTIES 12550 AURORA AVE N SEATTLE WA 98133 912146011 COMMUNITY HOUSING WA 501(C)(3) LINE 7 PROVAIL 1 AUBURN COMMUNITY LIVING 12550 AURORA AVE N SEATTLE WA 98133 911814582 COMMUNITY HOUSING WA 501(C)(3) LINE 7 PROVAIL 1 EASTSIDE COMMUNITY LIVING 12550 AURORA AVE N SEATTLE WA 98133 943206977 COMMUNITY HOUSING WA 501(C)(3) LINE 7 PROVAIL 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PROVAIL - AFFILIATES KING & SNOHOMISH COUNTIES D 122329 FMV