2016-04-28T18:33:17-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2015-01-01 911400684 PERSONAL SERVICE PROVIDERS PERS 3605381540 201 7TH STREET HOQUIAM WA 98550 TERRY FULTZ PRESIDENT 3605381540 2016-04-28 1 DANIEL M FREIN CPA P00856532 4252506100 2015 2016-09-27 15:27:22Z TERRY FULTZ 201 7TH STREET HOQUIAM WA 98550 1960509 0 X WWW.PSPROVIDERS.ORG X 1987 WA TO PROVIDE HOME CARE TO INDIVIDUALS RECOVERING AND IN NEED OF LONG-TERM CARE. 5 5 132 5 0 0 0 0 2431062 1933739 7883 -19945 208 15 2439153 1913809 0 0 0 0 2020708 1700992 0 0 0 387840 411937 2408548 2112929 30605 -199120 1210065 1029285 165028 184891 1045037 844394 TO PROVIDE HOME CARE (DOMESTIC, PERSONAL AND RESPITE) TO INDIVIDUALS RECOVERING FROM ILLNESS OR INJURY AND IN NEED OF LONG-TERM CARE. 0 0 1820771 0 1917081 HOME CARE AND HEALTH MAINTENANCE VISITS - DURING 2015, THE ORGANIZATION PROVIDED SERVICE TO 229 CLIENTS. 56514 0 16658 CAREGIVER TRAINING - TO PROVIDE INSTRUCTION TO IN-HOME CAREGIVERS. 1877285 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 9 0 1 132 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X TOM MAYR 3605325454 201 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 SCHNIEDER 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 132947 1 HOME CARE 812900 1917081 1917081 CAREGIVER TRAINING 611600 16658 16658 1933739 10632 10632 16123 46700 -30577 -30577 -30577 MISCELLANEOUS INCOME 900099 15 15 15 1913809 1933739 0 -19930 1207127 1072501 134626 398870 354386 44484 94995 84401 10594 132947 118120 14827 7397 6572 825 12575 11172 1403 14274 12682 1592 12839 11407 1432 59047 52462 6585 6227 5532 695 47588 42281 5307 46799 41580 5219 2294 2038 256 24580 21839 2741 28463 25289 3174 MISCELLANEOUS 10374 9218 1156 BAD DEBT 4182 3716 466 DUES AND SUBSCRIPTIONS 2351 2089 262 2112929 1877285 235644 0 253633 144422 234132 192706 2631 4406 105677 64377 82309 41300 637360 646451 1210065 1029285 165028 184891 165028 184891 X 1045037 844394 1045037 844394 1210065 1029285 -199120 -1522 0 X 0 1 X 1 0 X 5000 5000 2532587 2528510 2379963 2431062 1933739 11805861 2537587 2528510 2379963 2431062 1933739 11810861 0 0 0 11810861 20414 18887 16098 7883 10632 73914 20414 18887 16098 7883 10632 73914 54 59 222 208 15 558 2558055 2547456 2396283 2439153 1944386 11885333 0.99370 0.99320 0.00620 0.00680 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 103977 64377 39600 1700 1700 41300 X 1912287 -1522 -1522 1913809 0 1913809 2112929 0 2112929 0 2112929 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 EXEMPTION FROM INCOME TAX, AND HAS ADOPTED NO POSITIONS THAT ARE NOT HIGHLY LIKELY TO BE SUSTAINED IF EXAMINED BY RELEVANT AUTHORITIES. TAX YEARS ENDED PRIOR TO 2012 ARE CLOSED TO EXAMINATION. 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 B, LINE 11 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.