2020-07-09T14:54:47-05:00 2019-12-31 911623649 JOHNSON STONE & PAGANO PS 1501 REGENTS BLVD SUITE 100 FIRCREST WA 98466 990 2019-01-01 943080307 ASHLEY HOUSE ASHL 2535339050 33811 9TH AVE S FEDERAL WAY WA 98003 STEPHEN L FREEBORN PRESIDENT 2535339050 2020-07-07 1 CORA P KENWORTHY P01332199 2535667070 162.17.160.225 2020-07-07 13:23:43 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 3E061BD90FE31DA24F94CE165AC41780A4958EB1 2019 2020-09-23 17:36:50Z STEPHEN L FREEBORN 33811 9TH AVE S FEDERAL WAY WA 98003 10419901 0 X WWW.ASHLEYHOUSEKIDS.COM X 1989 WA ASHLEY HOUSE PROVIDES COMPREHENSIVE, COST EFFECTIVE, QUALITY CARE TO MEDICALLY FRAGILE CHILDREN AND YOUNG ADULTS IN A HOME-LIKE SETTING. 9 9 161 5 0 0 34396 24999 6889328 7681141 167430 852602 7489 5681 7098643 8564423 245196 116305 0 0 6171602 7146511 0 0 220845 1056328 1061845 7473126 8324661 -374483 239762 9197233 8935241 1431514 592742 7765719 8342499 WE ARE DEDICATED TO PROVIDING EDUCATION TO FAMILIES AND CAREGIVERS, BUILDING SUPPORT SYSTEMS, COORDINATING SERVICES AND NURTURING THE DEVELOPMENT OF EACH INDIVIDUAL. 0 0 5454881 116305 6213541 ASHLEY HOUSE PROVIDED TRANSITIONAL NURSING CARE SERVICES, HOSPICE SERVICES, CASE MANAGEMENT AND SOCIAL SERVICES TO 37 MEDICALLY FRAGILE CHILDREN IN 2019. FREE SERVICES WERE PROVIDED TO NEEDY CHILDREN IN 2019 VALUED AT APPROXIMATELY $116,305. 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. 1352373 0 1475413 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. 6807254 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 14 0 1 161 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 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 BARBARA HYLAND-HILL BOARD MEMBER 1.00 X 0 0 0 TOM VERTETIS BOARD MEMBER 0.50 X 0 0 0 WESTON KING BOARD MEMBER 0.50 X 0 0 0 BRAD ACKERMAN BOARD MEMBER 0.50 X 0 0 0 BECCA DUSKIN BOARD MEMBER 1.00 X 0 0 0 JESSICA MALAIER BOARD MEMBER 1.00 X 0 0 0 JENNIFER MANNHEIM 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 MICHAELA GOULD CONTROLLER 40.00 X 151023 0 13667 KEN MAAZ EXECUTIVE DIRECTOR 40.00 X 198352 0 13355 ERICA PERNELA DIRECTOR OF CLINICAL SERVICES 40.00 X 101414 0 14236 MARK SCHINDLER DIRECTOR OF HUMAN RESOURCES 40.00 X 103988 0 13563 MICHAEL PUGSLEY DIRECTOR OF DEVELOPMENT 40.00 X 134742 0 13771 KRISTINE SPENCER LPN 40.00 X 100391 0 15183 789910 0 83775 6 0 1 0 SUPPLEMENTAL HEALTH CARE 1010 S 336TH ST FEDERAL WAY WA 98003 TRAVELING NURSE 125987 GABBERT ARCHITECTS PLANNERS 20011 BALLINGER WAY NE 211 SHORELINE WA 98155 ARCHITECT PLANNING 119552 2 24999 5046 24999 MEDICAID: STATE FEE FOR SERVICE P 623000 4523881 4523881 INSURANCE 623000 3157260 3157260 7681141 47817 47817 1691676 950000 1614762 222129 76914 727871 804785 804785 16455 18587 -2132 -2132 MISCELLANEOUS 623000 7813 7813 7813 8564423 7688954 0 850470 116305 116305 609598 506717 86224 16657 5087039 4217607 726498 142934 914974 780388 116737 17849 534900 456906 65549 12445 578 578 13700 13700 20209 20209 85789 73008 12781 30791 25369 5422 51146 27615 22280 1251 64208 64208 95746 78211 12982 4553 42595 35979 4809 1807 13914 6392 6998 524 22428 1268 21160 222286 179636 42650 93024 70413 20820 1791 HOUSEHOLD, CLEANING, CH 121358 117406 3952 MISC OTHER 101340 52352 48701 287 TAXES & LICENSES 77403 61079 8358 7966 BANK FEES 4727 4727 603 603 8324661 6807254 1296562 220845 18279 213522 109145 83575 845808 876831 140366 149653 6828669 1764839 3837202 5063830 2460754 2227856 1785679 319974 9197233 8935241 716514 592742 715000 0 1431514 592742 X 7765719 8342499 7765719 8342499 9197233 8935241 239762 337018 0 X X 0 1 X 1 0 X 45474 35357 646529 34396 24999 786755 4156138 4875212 5116343 6889328 7681141 28718162 4201612 4910569 5762872 6923724 7706140 29504917 0 0 0 29504917 115297 96473 95646 64557 47817 419790 115297 96473 95646 64557 47817 419790 2004 4805 5829 7489 7813 27940 4318913 5011847 5864347 6995770 7761770 29952647 0.98510 0.98000 0.01400 0.01920 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 1176435 1176435 4708959 1098921 3610038 770066 605830 164236 173209 60088 113121 5063830 8783515 337018 18587 355605 8427910 20209 116304 136513 8564423 8206735 18587 18587 8188148 20209 116304 136513 8324661 PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 18,587. PART XI, LINE 4B - OTHER ADJUSTMENTS: UNCOMPENSATED CARE 116,304. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 18,587. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNCOMPENSATED CARE 116,304. 30TH ANNIVERSARY CELEBRATION 16455 16455 18587 16455 16455 18587 18587 -2132 0 GROUP HOME - ROOM & BOARD - UNCOMPENSATED CARE 13 116305 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 MICHAELA GOULD CONTROLLER 151023 0 0 0 0 0 1092 0 12575 0 164690 0 0 0 KEN MAAZ EXECUTIVE DIRECTOR 198352 0 0 0 0 0 780 0 12575 0 211707 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.