2018-04-07T19:17:13-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2017-01-01 911400684 PERSONAL SERVICE PROVIDERS PERS 3605381540 205 7TH STREET HOQUIAM WA 98550 TERRY FULTZ PRESIDENT 3605381540 2018-04-04 1 KURT BENNION P01469618 4252506100 2018-04-04 2017 2022-09-23 18:48:47Z TERRY FULTZ 205 7TH STREET HOQUIAM WA 98550 1648819 0 X WWW.PSPROVIDERS.ORG X 1987 WA TO PROVIDE HOME CARE TO INDIVIDUALS RECOVERING AND IN NEED OF LONG-TERM CARE. 4 4 91 6 0 0 0 0 1456051 1529918 8464 5894 6 0 1464521 1535812 0 0 0 0 1381765 1371769 0 0 0 384019 381298 1765784 1753067 -301263 -217255 710140 460572 163622 132770 546518 327802 TO PROVIDE HOME CARE (DOMESTIC, PERSONAL AND RESPITE) TO INDIVIDUALS RECOVERING FROM ILLNESS OR INJURY AND IN NEED OF LONG-TERM CARE. 0 0 1443301 0 1529918 HOME CARE AND HEALTH MAINTENANCE VISITS - DURING 2017, THE ORGANIZATION PROVIDED SERVICE TO 165 CLIENTS. 1443301 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 91 1 0 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X TOM MAYR 3605325454 205 7TH STREET HOQUIAM WA 98550 TERRY FULTZ PRESIDENT 1.00 X X 0 0 0 NORM SPRAGUE VICE PRESIDENT & TREASURER 1.00 X X 0 0 0 LOIS BANGERT SECRETARY (THROUGH SEPTEMBER 2017) 1.00 X X 0 0 0 JAMIE GRAVES DIRECTOR 1.00 X 0 0 0 JERRY KELTNER DIRECTOR 1.00 X 0 0 0 PAT SCHNEIDER DIRECTOR (THROUGH OCTOBER 2017) 1.00 X 0 0 0 JOEL STEPHENS CEO (THROUGH OCTOBER 2017) 10.00 X 0 0 0 LARRY BURGHER EXECUTIVE DIRECTOR 40.00 X 13500 0 0 TOM MAYR CFO 10.00 X 0 0 0 13500 0 0 0 0 0 0 HARBORS HOME HEALTH & HOSPICE 201 7TH STREET HOQUIAM WA 98550 MANAGEMENT SERVICES 117321 1 HOME CARE 812900 1529918 1529918 1529918 6702 6702 112199 112343 664 -144 -664 -808 -808 1535812 1529918 0 5894 13500 13500 966901 843042 123859 313768 263100 50668 77600 63888 13712 117321 55937 61384 160 132 28 12391 10202 2189 500 412 88 31140 25637 5503 49484 40740 8744 8439 6948 1491 13374 11011 2363 21366 17591 3775 83643 68864 14779 1370 1128 242 10312 8490 1822 BAD DEBT 18050 14860 3190 MISCELLANEOUS 10567 8700 1867 DUES AND SUBSCRIPTIONS 3181 2619 562 1753067 1443301 309766 0 113242 89197 127412 152691 15585 48711 43381 30621 5330 423280 213354 710140 460572 163622 132770 163622 132770 X 546518 327802 546518 327802 710140 460572 -217255 -1461 0 X 0 1 X 1 0 X 2379963 2431062 1933739 1456051 1529918 9730733 2379963 2431062 1933739 1456051 1529918 9730733 0 0 0 9730733 16098 7883 10632 8637 6702 49952 16098 7883 10632 8637 6702 49952 222 208 15 6 451 2396283 2439153 1944386 1464694 1536620 9781136 0.99480 0.99420 0.00510 0.00580 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 48711 43381 5330 5330 X 1534351 -1461 -1461 1535812 0 1535812 1753067 0 1753067 0 1753067 PART X, LINE 2: PERSONAL SERVICE PROVIDERS IS A NONPROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. THE ORGANIZATION IS CLASSIFIED AS A PUBLIC CHARITY. ACCORDINGLY, THERE IS NO PROVISION FOR FEDERAL INCOME TAXES ON THE FINANCIAL STATEMENTS. THE ORGANIZATION FILES FEDERAL FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, AND HAS ADOPTED NO POSITIONS THAT ARE NOT HIGHLY LIKELY TO BE SUSTAINED IF EXAMINED BY RELEVANT AUTHORITIES. THE ORGANIZATION HAS RECOGNIZED NO INTEREST OR PENALTIES RELATED TO TAXES IN THE ACCOMPANYING FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION COMPENSATES HARBORS HOME HEALTH & HOSPICE, AN UNRELATED 501(C)(3) ORGANIZATION, TO PROVIDE MANAGEMENT SERVICES. CEO SERVICES WERE PROVIDED THROUGH OCTOBER 2017 AND CFO SERVICES WERE PROVIDED FOR THE ENTIRE YEAR. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 WAS PREPARED BY A CERTIFIED PUBLIC ACCOUNTING FIRM AND REVIEWED BY THE ADMINISTRATOR, FINANCIAL MANAGER, AND DISTRIBUTED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS ITS BOARD MEMBERS AND EMPLOYEES CONTINUOUSLY TO ENSURE THAT CONFLICTS OF INTEREST ARE AVOIDED. THIS MANIFESTS ITSELF IN BOARD VOTES WHERE MEMBERS WITH POSSIBLE CONFLICTS OF INTEREST ABSTAIN FROM CERTAIN VOTES. EMPLOYEES ARE NOT ALLOWED TO MAINTAIN EMPLOYMENT WHERE A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15A THE SERVICES OF THE CEO AND OTHER OFFICERS ARE PROVIDED AS PART OF THE MANAGEMENT CONTRACT WITH HARBORS HOME HEALTH & HOSPICE. THEIR COMPENSATION IS DETERMINED BY HARBORS HOME HEALTH & HOSPICE. THE EXECUTIVE DIRECTOR'S COMPENSATION WAS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS IN 2017. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT OPEN TO THE PUBLIC. ONLY FORMS 990 AND 1023 ARE MADE AVAILABLE TO THE PUBLIC.