2016-05-16T08:46:17-05:00 2015-06-30 910605875 PETERSON SULLIVAN LLP CPA'S 601 UNION ST STE 2300 SEATTLE WA 981012345 990 2014-07-01 910593488 PROVAIL PROV 2063637303 12550 AURORA AVE N SEATTLE WA 98133 MICHAEL J HATZENBELER CEO 2063637303 2016-05-12 1 MATTHEW R MATSON P00775671 2063827777 2016-05-12 2014 2016-08-17 19:52:53Z MICHAEL J HATZENBELER 12550 AURORA AVE N SEATTLE WA 98133 13412841 0 X WWW.PROVAIL.ORG X 1942 WA PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 10 10 428 347 10069 8460 8457873 9401062 482696 442804 57345 8476 205736 258750 9203650 10111092 0 0 0 0 8196575 8258115 13977 0 386636 1325406 1434227 9535958 9692342 -332308 418750 8744478 9648310 6879109 7364191 1865369 2284119 PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 0 0 739919 280636 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 263 CLIENTS ARE SERVED EACH YEAR. 2179838 470044 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 278 CLIENTS. 5398213 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. 8317970 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 9 0 1 428 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 KATIE CISSELL 1ST VICE CHAIR 1.00 X X 0 0 0 DOUG MCFARLAND MEMBER 1.00 X 0 0 0 JIM CHESEMORE MEMBER 1.00 X 0 0 0 DOUG DURBIN MEMBER 1.00 X 0 0 0 CHRIS KING MEMBER 1.00 X 0 0 0 KEVIN KOPPES SECRETARY 1.00 1.00 X X 0 0 0 SKYLAR SHERWOOD MEMBER 1.00 X 0 0 0 HARRIS CLARKE MEMBER 1.00 1.00 X 0 0 0 ELIZABETH CROUCH MEMBER 1.00 X 0 0 0 JOANIE KIMMEL MEMBER 1.00 X 0 0 0 MICHAEL HATZENBELER CEO 40.00 1.00 X 127233 0 3942 JAMES MACKELLAR-HERTAN CFO 40.00 1.00 X 99715 0 3942 ALEXANDER GIBB DIRECTOR OF MFG. AND SALES 40.00 X 114794 0 3942 341742 0 11826 2 0 0 0 0 93808 321468 8888381 97405 9401062 REHABILITATION & DENTAL 900099 363033 363033 TRAUMATIC BRAIN INJURY PROGRAM 900099 79771 79771 442804 1476 1476 48451 35048 13403 13403 10069 3334 7000 0 7000 7000 7000 28611 321468 126077 -97466 -97466 3433200 3140624 292576 292576 MISCELLANEOUS 900099 28493 28493 EMPLOYMENT TRAINING 900099 15300 15300 LICENSE FEE 900099 6000 6000 444 444 50237 10111092 750680 10069 -50719 270320 240579 21165 8576 6745993 5999772 536422 209799 538270 488992 21728 27550 703532 646208 39746 17578 1668 1668 47239 41690 5549 173880 119955 35019 18906 38045 6551 1871 29623 184863 149748 27328 7787 121944 77607 41587 2750 148128 144881 1328 1919 42953 36481 4268 2204 170120 87719 76891 5510 98888 46021 51491 1376 75775 47517 27181 1077 GENERAL AND ADMINISTRAT 134289 70698 46320 17271 BAD DEBT 88462 55194 33268 TAXES, LICENSES AND FEE 56921 40787 15561 573 DUES & SUBSCRIPTIONS 51052 17570 32613 869 9692342 8317970 987736 386636 85930 103374 564373 1509386 1690434 1544256 290051 298295 42176 59444 7743741 1722031 5963908 6021710 87663 87663 19943 24182 8744478 9648310 1489831 1006330 134786 5355237 6210700 34041 12375 6879109 7364191 X 1755701 2125779 109668 158340 1865369 2284119 8744478 9648310 418750 0 X X 0 1 X 1 0 X 7865773 7834091 9197533 8457873 9401062 42756332 7865773 7834091 9197533 8457873 9401062 42756332 42756332 7343 2421 768 640 1476 12648 14215 77489 158892 132303 50237 433136 43202116 4832747 0.98970 0.99030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3263030 3263030 3084298 752474 2331824 1045822 969557 76265 350591 350591 6021710 DEFERRED RENT 12375 12375 GOLF TOURNAMENT 250853 236353 14500 47550 14354 3550 26180 LUNCHEON 62118 53443 8675 7962 14292 150 4307 4 37108 31672 5436 2307 750 4675 350079 321468 28611 57819 29396 3700 35162 126077 -97466 PATRICIA TOOLE SPOUSE OF A BOARD MEMBER 35522 PATRICIA IS EMPLOYED BY PROVAIL AS AN OCCUPATIONAL THERAPIST. 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 XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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