2017-04-26T19:40:06-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2016-01-01 911400684 PERSONAL SERVICE PROVIDERS PERS 3605381540 205 7TH STREET HOQUIAM WA 98550 TERRY FULTZ PRESIDENT 3605381540 2017-04-19 1 KURT BENNION P01469618 4252506100 67.137.57.251 2017-04-19 08:44:54 PD P E8F928E9D0C866B10A8A9E52340F1A707FC238CD E8F928E9D0C866B10A8A9E52340F1A707FC238CD 2016 2021-01-29 14:40:06Z X TERRY FULTZ 205 7TH STREET HOQUIAM WA 98550 1599604 0 X WWW.PSPROVIDERS.ORG X 1987 WA TO PROVIDE HOME CARE TO INDIVIDUALS RECOVERING AND IN NEED OF LONG-TERM CARE. 5 5 103 5 0 0 0 0 1933739 1456051 -19945 8464 15 6 1913809 1464521 0 0 0 0 1700992 1381765 0 0 0 411937 384019 2112929 1765784 -199120 -301263 1029285 710140 184891 163622 844394 546518 TO PROVIDE HOME CARE (DOMESTIC, PERSONAL AND RESPITE) TO INDIVIDUALS RECOVERING FROM ILLNESS OR INJURY AND IN NEED OF LONG-TERM CARE. 0 0 1392783 0 1439347 HOME CARE AND HEALTH MAINTENANCE VISITS - DURING 2016, THE ORGANIZATION PROVIDED SERVICE TO 161 CLIENTS. 39063 0 16704 CAREGIVER TRAINING - TO PROVIDE INSTRUCTION TO IN-HOME CAREGIVERS. 1431846 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 6 0 103 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X TOM MAYR 3605325454 205 7TH STREET HOQUIAM WA 98550 X 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 1.00 X X 0 0 0 JERRY KELTNER DIRECTOR 1.00 X 0 0 0 PAT SCHNEIDER DIRECTOR 1.00 X 0 0 0 JOEL STEPHENS CEO 10.00 X 0 0 0 TOM MAYR CFO 10.00 X 0 0 0 0 0 0 0 0 0 0 HARBORS HOME HEALTH & HOSPICE 201 7TH STREET HOQUIAM WA 98550 MANAGEMENT SERVICES 118490 1 HOME CARE 812900 1439347 1439347 CAREGIVER TRAINING 611600 16704 16704 1456051 8637 8637 134910 135083 -173 -173 -173 MISCELLANEOUS INCOME 900099 6 6 6 1464521 1456051 0 8470 984999 798721 186278 318675 258408 60267 78091 63323 14768 118490 96082 22408 203 165 38 11555 9370 2185 11189 9073 2116 47024 38130 8894 9488 7694 1794 35495 28782 6713 85384 69237 16147 1003 813 190 15110 12252 2858 23520 19072 4448 BAD DEBT 14916 12095 2821 MISCELLANEOUS 10132 8216 1916 DUES AND SUBSCRIPTIONS 510 413 97 1765784 1431846 333938 0 144422 113242 192706 127412 4406 15585 110108 79487 41300 30621 646451 423280 1029285 710140 184891 163622 184891 163622 X 844394 546518 844394 546518 1029285 710140 -301263 3387 0 X 0 1 X 1 0 X 2528510 2379963 2431062 1933739 1456051 10729325 2528510 2379963 2431062 1933739 1456051 10729325 0 0 0 10729325 18887 16098 7883 10632 8637 62137 18887 16098 7883 10632 8637 62137 59 222 208 15 6 510 2547456 2396283 2439153 1944386 1464694 10791972 0.99420 0.99370 0.00580 0.00620 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 110108 79487 30621 30621 X 1467908 3387 3387 1464521 0 1464521 1765784 0 1765784 0 1765784 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. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED IN MAY 2015. THOSE AMENDMENTS INCLUDE THE FOLLOWING SIGNIFICANT CHANGES. 1. THE NUMBER OF BOARD MEMBERS WAS CHANGED FROM A RANGE OF THREE TO NINE INDIVIDUALS TO A RANGE OF FIVE TO SEVEN INDIVIDUALS. 2. THE EXECUTIVE VICE PRESIDENT WAS REMOVED FROM THE LIST OF OFFICERS. 3. THE BOARD WAS GIVEN POWER TO CREATE TEMPORARY OR STANDING COMMITTEES, WITH THE LIMITATION THAT THOSE COMMITTEES MAY NOT MAKE SIGNIFICANT DECISIONS FOR THE ORGANIZATION. 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 15 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. 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.