2017-02-01T14:56:26-06:00 2016-06-30 910605875 Peterson Sullivan LLP CPA'S 601 Union St Ste 2300 Seattle WA 981012345 990 2015-07-01 910593488 Provail PROV 2063637303 12550 Aurora Ave N Seattle WA 98133 michael j hatzenbeler CEO 2063637303 2017-01-26 1 Matthew R Matson P00775671 2063827777 2017-01-26 2015 2021-01-29 14:40:06Z Michael J Hatzenbeler 12550 Aurora Ave N Seattle WA 98133 15004826 0 X WWW.PROVAIL.ORG X 1942 WA PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 10 10 443 112 9745 8745 9401062 10753326 442804 325518 8476 -2676 258750 280214 10111092 11356382 0 0 0 0 8258115 9694231 0 0 455219 1434227 1478361 9692342 11172592 418750 183790 9648310 12103393 7364191 9635484 2284119 2467909 PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 0 0 6120987 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. 2813725 409832 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 376 clients. 669132 206398 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 253 clients are served each year. 9603844 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 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 12 0 1 443 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 0 0 X James MacKellar-Hertan 2063637303 12550 Aurora Ave N Seattle WA 98133 Ken Toole Chair 1.00 1.00 X X 0 0 0 Harris Clarke 1st Vice Chair 1.00 1.00 X X 0 0 0 Kevin Koppes Secretary 1.00 1.00 X X 0 0 0 Judy Pickar Treasurer 1.00 1.00 X X 0 0 0 Jim Chesemore Director 1.00 X 0 0 0 Doug Durbin Director 1.00 X 0 0 0 Mike Hughes Director 1.00 X 0 0 0 Denise Kajannoff Director 1.00 X 0 0 0 Chris King Director 1.00 X 0 0 0 Rob Rosson Director 1.00 X 0 0 0 Michael Hatzenbeler CEO 40.00 1.00 X 136869 0 3959 James MacKellar-Hertan CFO 40.00 1.00 X 105717 0 3959 Alexander Gibb Director of Mfg. and Sales 40.00 X 122064 0 3959 364650 0 11877 3 0 0 0 0 35213 322327 10058033 337753 96565 10753326 REHABILITATION & DENTAL 900099 250130 250130 traumatic brain injury program 900099 75388 75388 325518 2213 2213 49639 34813 14826 14826 9745 5081 4889 -4889 -4889 -4889 92174 322327 143683 -51509 -51509 3728942 3465059 263883 263883 Employment Training 900099 26829 26829 Lease Deposit Refund 900099 20000 20000 Miscellaneous 900099 5717 5717 468 468 53014 11356382 616230 9745 -22919 297996 265300 21724 10972 7908138 7030386 581898 295854 633454 591027 31703 10724 854643 786397 44474 23772 1661 1661 40710 33692 7018 265500 147797 106738 10965 61413 5195 1976 54242 189810 155869 24371 9570 127062 87411 36927 2724 142091 138052 1961 2078 49711 40308 6948 2455 174002 93521 73527 6954 89492 47373 40164 1955 75516 50258 24360 898 GENERAL AND ADMINISTRAT 104744 44463 41186 19095 DUES & SUBSCRIPTIONS 71326 11729 58499 1098 Bad Debt 53833 51970 1863 TAXES, LICENSES AND FEE 31490 23096 8394 11172592 9603844 1113529 455219 103374 72877 1509386 1491402 1544256 1689819 298295 442560 59444 91687 9778510 1606089 6021710 8172421 87663 87663 24182 54964 9648310 12103393 1006330 1487342 134786 537 6210700 8147605 12375 0 7364191 9635484 X 2125779 2285618 158340 182291 2284119 2467909 9648310 12103393 183790 0 X 0 1 X 1 0 X 7834091 9197533 8457873 9401062 10753326 45643885 7834091 9197533 8457873 9401062 10753326 45643885 45643885 2421 768 640 1476 2213 7518 77489 158892 132303 50237 26185 445106 46096509 3957929 0.99020 0.98970 X Schedule A, Part II, Line 10, Explanation of Other Income: MISCELLANEOUS Laundry Income lease deposit refund RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3263030 3263030 3012417 845806 2166611 1082675 760283 322392 2420388 2420388 8172421 Golf Tournament 327926 250878 77048 56067 24505 3600 24170 Luncheon 74790 61750 13040 9020 13040 100 5204 3 11785 9699 2086 750 7227 414501 322327 92174 65087 38295 3700 36601 143683 -51509 patricia toole spouse of a board member 32419 Patricia is employed by Provail as an occupational therapist. 0 X Auction Items 133 96565 FMV 0 0 0 Form 990, Part VI, Section B, line 11 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 15a 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. 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