2021-11-09T12:09:04-06:00 2020-12-31 911623649 JOHNSON STONE & PAGANO PS 1501 REGENTS BLVD SUITE 100 FIRCREST WA 98466 990 2020-01-01 943080307 ASHLEY HOUSE ASHL 2535339050 33811 9TH AVE S FEDERAL WAY WA 98003 STEPHEN L FREEBORN PRESIDENT 2535339050 2021-11-05 1 STEPHEN FREEBORN XXX-XX-XXXX CORA P KENWORTHY P01332199 2535667070 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEPHEN L FREEBORN 33811 9TH AVE S FEDERAL WAY WA 98003 10162061 0 X WWW.AH-NW.ORG X 1989 WA ASHLEY HOUSE PROVIDES COMPREHENSIVE, COST EFFECTIVE, QUALITY CARE TO MEDICALLY FRAGILE CHILDREN AND YOUNG ADULTS IN A HOME-LIKE SETTING. 7 7 175 8 0 0 24999 346287 7681141 9158182 852602 105335 5681 36289 8564423 9646093 116305 185898 0 0 7146511 7653867 0 0 648040 1061845 1246048 8324661 9085813 239762 560280 8935241 13301517 592742 4164145 8342499 9137372 WE ARE DEDICATED TO PROVIDING EDUCATION TO FAMILIES AND CAREGIVERS, BUILDING SUPPORT SYSTEMS, COORDINATING SERVICES AND NURTURING THE DEVELOPMENT OF EACH INDIVIDUAL. 0 0 5633859 185898 7476584 ASHLEY HOUSE PROVIDED TRANSITIONAL NURSING CARE SERVICES, HOSPICE SERVICES, CASE MANAGEMENT AND SOCIAL SERVICES TO 37 MEDICALLY FRAGILE CHILDREN IN 2020. FREE SERVICES WERE PROVIDED TO NEEDY CHILDREN IN 2020 VALUED AT APPROXIMATELY $185,898. ASHLEY HOUSE PROVIDES THESE SERVICES IN FIVE GROUP HOMES, IN FAMILY-LIKE SETTINGS. THE HOMES ARE STAFFED 24 HOURS A DAY WITH NURSES AND CNA'S. ADDITIONAL STAFF ARE UTILIZED TO TAKE CHILDREN TO MEDICAL APPOINTMENTS, AND ON OUTINGS. OUR SPECIFIC OBJECTIVE IS TO ENABLE CHILDREN TO BE RETURNED TO THEIR OWN HOME, OR TO SEEK ADOPTION OR FOSTER CARE. HENCE, WE ARE A SETTING FOR TRANSITIONAL CARE UNTIL PERMANENCY IS OBTAINED. 1460780 1717762 ASHLEY HOUSE YOUNG ADULT RESIDENTIAL GROUP HOME ACCEPTS UP TO 6 YOUNG ADULTS (18-30 YEARS OLD) WITH MEDICAL COMPLEXITY TO LIVE IN A HOME-LIKE SETTING (SHORT OR LONG TERM). THESE MEDICALLY FRAGILE YOUNG ADULTS ARE OFTEN INDIVIDUALS WITH COMPLICATED MEDICAL HISTORIES, SUCH AS ORGAN TRANSPLANTATION, VENTILATOR DEPENDENCY OR TRAUMATIC BRAIN INJURY AND EXPERIENCE LENGTHY HOSPITALIZATIONS, NEED SPECIALIZED CAREGIVER TRAINING, AND HAVE EQUIPMENT OR NURSING NEEDS THAT MAY EXCEED WHAT CAN BE PROVIDED IN THEIR FAMILY HOMES. 7094639 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 15 0 1 175 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X X KEN MAAZ 2535339050 33811 9TH AVE S FEDERAL WAY WA 98003 TOM VERTETIS BOARD MEMBER 0.50 X 0 0 0 KEVIN BLAKE BOARD MEMBER 1.00 X 0 0 0 SHARRY EDWARDS BOARD MEMBER 0.50 X 0 0 0 STEPHEN L FREEBORN PRESIDENT 1.00 X X 0 0 0 CINDY GRADY SECRETARY/TREASURER 1.00 X X 0 0 0 DAN BOGART BOARD MEMBER 1.00 X 0 0 0 KAREN QUANDT BOARD MEMBER 1.00 X 0 0 0 ELIZABETH KAUKL BOARD MEMBER 1.00 X 0 0 0 JULIE FOLEY BOARD MEMBER 1.00 X 0 0 0 KEN MAAZ EXECUTIVE DIRECTOR 40.00 X 173923 0 12176 ERICA PERNELA DIRECTOR OF CLINICAL SERVI 40.00 X 115415 0 17683 MARK SCHINDLER DIRECTOR OF HUMAN RESOURCE 40.00 X 115969 0 17711 SARA EDWARDS CONTROLLER 40.00 X 105266 0 17028 MICHAELA GOULD DEVELOPEMENT LIASON 40.00 X 151238 0 18826 MICHAEL PUGSLEY DIRECTOR OF DEVELOPMENT 40.00 X 134934 0 18687 KRISTINE SPENCER LPN 40.00 X 107695 0 16447 CAROL JACKSON REGISTERED NURSE 40.00 X 103083 0 15834 1007523 0 134392 8 0 1 0 SQUARE PEG CONSTRUCTION LLC 1010 S 336TH ST SUITE 108 FEDERAL WAY WA 98003 CONTRACTOR FOR NEW SHORELINE BUILDING 1954557 IT SOURCE PO BOX 77570 SEATTLE WA 98177 IT HELP DESK AND ADMINISTRATION, END USE 116167 2 132116 214171 35172 346287 INSURANCE 623000 4765852 4765852 MEDICAID: STATE FEE FO 623000 4392330 4392330 9158182 42950 42950 577853 500 514784 1184 63069 -684 62385 62385 125 0 125 125 MISCELLANEOUS 623000 36164 36164 36164 9646093 9194346 0 105460 185898 185898 575168 469861 73615 31692 5512783 4487871 709515 315397 1048244 879734 128241 40269 517672 420644 73473 23555 672 672 14270 14270 22193 22193 181383 800 3500 177083 18771 13331 4465 975 88184 31364 54092 2728 91281 91281 91820 76235 13243 2342 27812 23154 3907 751 17195 11378 5513 304 57862 39066 4538 14258 202392 158619 43773 101649 76402 22593 2654 HOUSEHOLD, CLEANING, CH 141481 126230 2692 12559 MISC OTHER 114299 79039 28801 6459 TAXES & LICENSES 37933 11220 9699 17014 BANK FEES 33078 20 33058 3773 3773 9085813 7094639 1343134 648040 213522 386192 83575 83571 876831 1356998 149653 157880 6898485 1947763 5063830 4950722 2227856 2546160 319974 3819994 8935241 13301517 592742 994585 3169560 592742 4164145 X 8342499 9127372 10000 8342499 9137372 8935241 13301517 560280 234593 0 X X 0 1 X 1 0 X 35357 646529 34396 24999 346287 1087568 4875212 5116343 6889328 7681141 9158182 33720206 4910569 5762872 6923724 7706140 9504469 34807774 0 0 0 34807774 96473 95646 64557 47817 42950 347443 96473 95646 64557 47817 42950 347443 4805 5829 7489 7813 36164 62100 5011847 5864347 6995770 7761770 9583583 35217317 0.98840 0.98510 0.00990 0.01400 X PART III SECTION B LINE 12 OTHER INCOME CPR/FIRST AID FEES, REBATES, CLASS ACTION PROCEEDS FROM SECURITIES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 1 20539 20539 1 0 0 PART II-B, LINE 1: ASHLEY HOUSE PAID A CONSULTANT TO LOBBY ON THEIR BEHALF FOR FUNDING TO PURCHASE AND REMODEL A HOME IN SPOKANE, WA FOR CRITICALLY ILL CHILDREN. 1176435 1176435 4708959 1230693 3478266 832732 646227 186505 180359 70843 109516 4950722 CONSTRUCTION IN PROGRESS 3819994 3819994 9672596 234593 234593 9438003 22192 185898 208090 9646093 8877723 0 8877723 22192 185898 208090 9085813 PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES PART XI, LINE 4B - OTHER ADJUSTMENTS: UNCOMPENSATED CARE 185,898. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES PART XII, LINE 4B - OTHER ADJUSTMENTS: UNCOMPENSATED CARE 185,898. 0 GROUP HOME - ROOM & BOARD - UNCOMPENSATED CARE 79 185898 OTHER ROOM & BOARD PROVIDED AT NO COST. PART III LINE 1 FUNDS ARE NOT GIVEN TO ANY INDIVIDUAL. THE COST TO THE AGENCY FOR ROOM AND BOARD IS INCLUDED AS A GRANT TO INDIVIDUALS WHEN ASHLEY HOUSE DOES NOT RECEIVE ANY REIMBURSEMENT FOR THESE SERVICES. X X X X 0 0 0 0 0 0 0 0 0 KEN MAAZ EXECUTIVE DIRECTOR 173923 0 0 0 0 0 0 0 12176 0 186099 0 0 0 MICHAELA GOULD DEVELOPEMENT LIASON 151238 0 0 0 0 0 6650 0 12176 0 170064 0 0 0 MICHAEL PUGSLEY DIRECTOR OF DEVELOPMENT 134934 0 0 0 0 0 6511 0 12176 0 153621 0 0 0 X MISCELLANEOUS 0 17280 X HOSPITAL EQUIPMENT 21 12000 FMV X WINDOWS PROGRAM 1 5892 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE 990 REVIEW IS LISTED ON THE YEARLY BOARD OF DIRECTORS COMPLIANCE CALENDAR TO REMIND ALL BOARD MEMBERS OF THE REVIEW. FORM 990 IS PREPARED AFTER THE COMPLETION OF THE INDEPENDENT FINANCIAL AUDIT. A COMPLETE COPY OF THE 990 IS INDIVIDUALLY PROVIDED TO ALL BOARD MEMBERS WHO REVIEW THE RETURN PRIOR TO FILING. ANY QUESTIONS OR CONCERNS ARE COMPILED BY THE BOARD TREASURER, WHO THEN CONTACTS THE RETURN PREPARER AND/OR AUDITORS AS NECESSARY. AFTER THE BOARD HAS REVIEWED AND ACCEPTED THE RETURN, BY VOTE AT A REGULARLY SCHEDULED BOARD MEETING, IT IS SIGNED BY THE BOARD PRESIDENT AND FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD COMPLIANCE CALENDAR LISTS AS AN ITEM TO BE COMPLETED IN THE FIRST QUARTER OF THE YEAR, REVIEW THE CONFLICT OF INTEREST POLICY. IT REQUIRES ALL BOARD MEMBERS TO ANNUALLY SIGN A CONFLICT OF INTEREST STATEMENT. THE POLICY ALSO REQUIRES A DUTY TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST. IT OUTLINES PROCEDURES FOR THE BOARD TO FOLLOW IN DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS AND PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST THAT MAY ARISE. ADDITIONALLY, INDEPENDENT FINANCIAL AUDITORS ANNUALLY REVIEW AND TEST THE ORGANIZATION'S RECORDS FOR POSSIBLE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 A BOARD COMMITTEE CONDUCTS AN ANNUAL PERFORMANCE AND COMPENSATION REVIEW FOR THE EXECUTIVE DIRECTOR. THE COMMITTEE ALSO OBTAINS COMPARABLE SALARY INFORMATION FROM INDEPENDENT THIRD-PARTY SOURCES AND DETERMINES ANY RECOMMENDATION FOR SALARY ADJUSTMENT. A WRITTEN EMPLOYMENT CONTRACT IS USED TO DOCUMENT ALL TERMS OF THE EXECUTIVE DIRECTOR'S EMPLOYMENT. THE EXECUTIVE DIRECTOR COMPLETES PERFORMANCE REVIEW AND OBTAINS COMPARABLE SALARY INFORMATION FOR ALL KEY EMPLOYEES. THE FULL BOARD REVIEW AND APPROVES COMPENSATION PACKAGES FOR BOTH THE EXECUTIVE DIRECTOR AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE OF GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE NOT GENERALLY MADE AVAILABLE TO THE PUBLIC, BUT ARE PROVIDED ON A REQUEST BASIS. FORM 990 PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO THE PROCESS FROM THE PRIOR YEAR.