2018-05-15T16:36:49-05:00 2017-06-30 910605875 Peterson Sullivan LLP CPA'S 601 Union St Ste 2300 Seattle WA 981012345 990 2016-07-01 910593488 Provail PROV 2063637303 12550 Aurora Ave N Seattle WA 98133 michael j hatzenbeler CEO 2063637303 2018-05-15 1 Matthew R Matson P00775671 2063827777 2018-05-15 2016 2022-09-23 18:48:47Z Michael J Hatzenbeler 12550 Aurora Ave N Seattle WA 98133 16217741 0 X WWW.PROVAIL.ORG X 1942 WA PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 10 10 471 124 9067 8067 10753326 11780181 325518 436300 -2676 857 280214 277022 11356382 12494360 0 0 0 0 9694231 10564180 0 0 509337 1478361 1839698 11172592 12403878 183790 90482 12103393 11674150 9635484 9115759 2467909 2558391 X PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 1 0 6530243 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 64 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. 3284253 399868 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 425 clients. 843481 362732 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 298 clients are served each year. 10657977 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 17 0 1 471 1 1 1 0 0 0 0 1 1 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X Shelleen Delaney 2063637303 12550 Aurora Ave N Seattle WA 98133 Ken Toole Immediate Past Chair 1.00 X X 0 0 0 Harris Clarke Chair 1.00 1.00 X X 0 0 0 Kevin Koppes Secretary 1.00 1.00 X X 0 0 0 Jim Chesemore Director 1.00 X 0 0 0 Mike Hughes Treasurer 1.00 1.00 X X 0 0 0 Denise Kajannoff 1st Vice Chair 1.00 1.00 X X 0 0 0 Steve Suter 2nd Vice Chair 1.00 1.00 X X 0 0 0 Don Black Director 1.00 X 0 0 0 Dale DeWhitt Director 1.00 X 0 0 0 Dave Murrujo Director 1.00 X 0 0 0 Michael Hatzenbeler CEO 40.00 1.00 X 153245 0 4673 James MacKellar-Hertan CFO 40.00 1.00 X 120998 0 4673 Alexander Gibb Director of Mfg. and Sales 40.00 X 132017 0 4673 406260 0 14019 3 0 1 0 0 2500 272951 11229611 275119 83043 11780181 REHABILITATION & DENTAL 900099 361300 361300 traumatic brain injury program 900099 75000 75000 436300 857 857 50698 36693 14005 14005 9067 4938 99427 272951 170876 -71449 -71449 3794915 3515812 279103 279103 Employment Training 900099 47197 47197 Miscellaneous 900099 7624 7624 Security Deposit Forfeitures 900099 339 339 203 203 55363 12494360 762600 9067 -57488 315213 281587 22868 10758 8650411 7722872 630874 296665 718109 657253 41128 19728 880447 803526 52965 23956 7104 1900 5204 55800 51136 4664 396180 246689 64940 84551 38031 7749 4094 26188 204180 152933 40175 11072 201662 154382 44202 3078 154490 150205 1816 2469 61338 53279 7422 637 187368 93783 87084 6501 132474 79908 49654 2912 92205 59827 31630 748 GENERAL AND ADMINISTRAT 127196 59293 48460 19443 DUES & SUBSCRIPTIONS 105682 16451 88600 631 Bad Debt 65204 65204 TAXES, LICENSES AND FEE 10784 10784 12403878 10657977 1236564 509337 72877 262715 1491402 415516 1689819 1791260 442560 556961 91687 57687 10300255 1830228 8172421 8470027 87663 87663 54964 32321 12103393 11674150 1487342 1262007 537 8147605 7853752 9635484 9115759 X 2285618 2533391 182291 25000 2467909 2558391 12103393 11674150 90482 0 X 0 1 X 1 0 X 9197533 8457873 9401062 10753326 11780181 49589975 9197533 8457873 9401062 10753326 11780181 49589975 49589975 768 640 1476 2213 857 5954 2361 16096 10069 9745 9067 47338 158892 132303 50237 26185 8165 375782 50019049 3681638 0.99140 0.99020 X Schedule A, Part II, Line 10, Explanation of Other Income: MISCELLANEOUS Laundry Income lease deposit refund Security Deposit Forfeitures RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3385799 3385799 5720896 972040 4748856 1193560 858188 335372 8470027 Golf Tournament 149040 93142 55898 57226 43819 4005 Gala 211233 175756 35477 4451 35478 3505 7390 3 12105 4053 8052 3600 8052 1700 1650 372378 272951 99427 65277 87349 9210 9040 170876 -71449 X X X X 0 0 0 0 0 0 0 1 0 Michael Hatzenbeler CEO 143245 0 10000 0 0 0 0 0 4673 0 157918 0 0 0 Part I, Line 7 The CEO was awarded a $10K bonus for his performance for the year by the Board of Directors. patricia toole spouse of a board member 34960 Patricia is employed by Provail as an occupational therapist. 0 X Auction Items 243 83043 FMV 0 0 0 Form 990, Part III, line 2 In the fiscal year ending July 30, 2017, Provail opened its BrainSpace boarding home for survivors of Traumatic Brain Injury. This 12 bed facility had been in the works for nearly 7 years from initial concept, through the funding process with state and county governments, construction and licensing processes and was opened to receive its first boarders on February 13, 2017. 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 member 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