2021-05-17T21:19:45-05:00 2020-06-30 135381590 BDO USA LLP 601 UNION ST STE 2300 SEATTLE WA 981012345 990 2019-07-01 910593488 PROVAIL PROV 2063637303 12550 AURORA AVE N SEATTLE WA 98133 MICHAEL J HATZENBELER CEO 2063637303 2021-05-17 1 MATTHEW R MATSON P00775671 2063827777 2021-05-18 2019 2022-09-23 18:48:47Z MICHAEL J HATZENBELER 12550 AURORA AVE N SEATTLE WA 98133 21911485 0 X WWW.PROVAIL.ORG X 1942 WA PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 21 21 531 37 -1629 -2430 15347756 18547491 675119 702938 1269121 2400057 -30322 118821 17261674 21769307 0 0 0 0 13876677 16370132 0 5663 420210 2074125 2152588 15950802 18528383 1310872 3240924 12615129 16262574 8946809 9353330 3668320 6909244 PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 0 0 10304623 789431 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 OPEND OUR BRAINSPACE BOARDING HOME FOR SURVIVERS OF TRAUMATIC BRAIN INJURY IN FEBRUARY 2017 WITH SPACE TO SERVE 12 BOARDERS WITH A CURRENT 11 BOARDER STATUS. 5229968 13303 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 485 CLIENTS. 1022218 6300 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 178 CLIENTS WERE SERVED THIS YEAR. 16556809 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 11 0 1 531 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 21 21 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X BEN ROBINSON 2063637303 12550 AURORA AVE N SEATTLE WA 98133 MICHAEL HATZENBELER CEO 40.00 1.00 X 236053 0 3859 BEN ROBINSON DIRECTOR OF FINANCE 40.00 1.00 X 140987 0 62 DENISE KAJANOFF CHAIR 1.00 1.00 X X 0 0 0 STEVE SUTER 1ST VICE CHAIR 1.00 1.00 X X 0 0 0 TERRIE DIEDESHEIMER 2ND VICE CHAIR 1.00 1.00 X X 0 0 0 MIKE HUGHES TREASURER 1.00 1.00 X X 0 0 0 TERRI SUTTON SECRETARY 1.00 1.00 X X 0 0 0 HARRIS CLARKE IMMEDIATE PAST CHAIR 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 DALE DEWITT DIRECTOR 1.00 X 0 0 0 BRANDON CHISHOLM DIRECTOR 1.00 X 0 0 0 JASON PETERSON DIRECTOR 1.00 X 0 0 0 WHITNEY KEYES DIRECTOR 1.00 X 0 0 0 ALESHE MORGAN MARTINEZ DIRECTOR 1.00 X 0 0 0 DOUGLAS BOWES DIRECTOR 1.00 X 0 0 0 HEALTH ALDER DIRECTOR 1.00 X 0 0 0 BRET KOBES DIRECTOR 1.00 X 0 0 0 DR BINH LIEU DIRECTOR 1.00 X 0 0 0 REX LUND DIRECTOR 1.00 X 0 0 0 JULIA COLLINS DIRECTOR 1.00 X 0 0 0 DOROTHY HARDIN DIRECTOR 1.00 X 0 0 0 JIM MITCHELL DIRECTOR 1.00 X 0 0 0 AMANDA VAN HOOK DIRECTOR 1.00 X 0 0 0 377040 0 3921 2 0 1 0 0 161548 18028375 357568 7053 18547491 REHABILITATION & DENTAL 900099 667246 667246 COMMUNITY HOUSING 531110 29392 29392 TRAUMATIC BRAIN INJURY PROGRAM 900099 6300 6300 702938 245 245 54149 56856 -2707 -2707 -1629 -1078 2477204 77392 2399812 2399812 2399812 0 161548 7930 -7930 -7930 SCHOOL 900099 81320 81320 MEETINGS, REFUNDS, AND OTHER 900099 23362 23362 EMPLOYMENT TRAINING 900099 13303 13303 11473 11473 129458 21769307 809034 -1629 2414411 346184 320875 18457 6852 13799689 12790824 735735 273130 932875 864674 49737 18464 1291384 1196974 68850 25560 12027 12027 59567 10067 49500 5663 5663 371419 194964 149831 26624 418905 318913 99392 600 150132 149150 499 483 178576 12517 165988 71 252209 155694 96021 494 GENERAL AND ADMINISTRAT 412539 412539 REPAIRS AND MAINTENANCE 139507 74718 64789 EQUIPMENT 96080 54900 40538 642 OTHER FUNDRAISING COSTS 61627 61627 18528383 16556809 1551364 420210 3096388 6354870 29923 99545 1252917 1583192 100000 0 97643 107791 9504513 1489118 7837313 8015395 87663 87663 113282 14118 12615129 16262574 1292207 1601760 58444 7654602 5787011 0 1906115 8946809 9353330 X 3668320 6811844 0 97400 3668320 6909244 12615129 16262574 3240924 0 X 0 0 0 X 10753326 11780181 12830097 15347756 18547491 69258851 10753326 11780181 12830097 15347756 18547491 69258851 69258851 19224 18733 19015 20095 21802 98869 9745 9067 12538 12118 0 43468 26185 8165 17479 58622 23362 133813 69535001 3421780 0.99600 0.99500 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS LAUNDRY INCOME LEASE DEPOSIT REFUND SECURITY DEPOSIT FORFEITURES MEETINGS REFUNDS AND OTHER RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3350549 3350549 5620874 1084489 4536385 93455 90598 2857 439635 314031 125604 8015395 CAMP IN 2020 161548 161548 7930 161548 161548 7930 7930 -7930 X 0 1 X X X X 0 0 0 0 0 1 0 1 0 MICHAEL HATZENBELER CEO 193207 0 42846 0 0 0 0 0 3859 0 239912 0 0 0 PART I, LINE 1A PROVAIL PAID THE ROTARY CLUB DUES FOR THE CEO, $600 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 WILL PROVIDE A DRAFT COPY OF THE FORM 990 TO THE GOVERNING BOARD APPROXIMATELY TWO WEEKS PRIOR TO IT BEING FILED AND REQUEST ANY QUESTIONS OR COMMENTS BE DIRECTED TO THE CFO. THE ORGANIZATION WILL PROVIDE A DRAFT COPY OF THE FORM 990 TO THE MANAGEMENT OF THE ORGANIZATION APPROXIMATELY TWO WEEKS PRIOR TO IT BEING FILED AND REQUEST ANY QUESTIONS OR COMMENTS BE DIRECTED TO THE CFO. 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 GETTING INPUT FROM THE BOD AND EMPLOYEES SUPERVISED BY THE CEO. THEY ALSO REVIEWED SALARIES AT COMPARABLE AGENCIES BY PULLING 990'S FOR THEM. 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 THESE ARE AVAILABLE UPON REQUEST. FORM 990, PART IV, LINE 12B AFFILIATED GROUP MEMBERS LIST OF ALL MEMBERS OF THE GROUP THIS RETURN WILL COVER: PROVAIL 12550 AURORA AVE. N SEATTLE, WA 98133 EIN 91-0593488 LIST OF ALL MEMBERS OF THE GROUP THIS RETURN WILL NOT COVER: AUBURN COMMUNITY LIVING 12550 AURORA AVE. N SEATTLE, WA 98133 EIN 91-1814582 EASTSIDE COMMUNITY LIVING 12550 AURORA AVE. N SEATTLE, WA 98133 EIN 94-3206977 PROVAIL - AFFILIATES 12550 AURORA AVE N SEATTLE WA 98133 912146011 COMMUNITY HOUSING WA 501(C)(3) 7 PROVAIL 1 AUBURN COMMUNITY LIVING 12550 AURORA AVE N SEATTLE WA 98133 911814582 COMMUNITY HOUSING WA 501(C)(3) 7 PROVAIL 1 EASTSIDE COMMUNITY LIVING 12550 AURORA AVE N SEATTLE WA 98133 943206977 COMMUNITY HOUSING WA 501(C)(3) 7 PROVAIL 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0