2014-05-08T13:38:34-05:00 2013-06-30 910605875 PETERSON SULLIVAN LLP CPA'S 601 UNION ST STE 2300 SEATTLE WA 981012345 990 2012-07-01 910593488 PROVAIL PROV 2063637303 12550 AURORA AVE N SEATTLE WA 98133 MICHAEL J HATZENBELER 2063637303 2014-04-07 1 MATTHEW R MATSON P00775671 2063827777 2014-04-07 2012 2015-11-30 17:44:51Z MICHAEL J HATZENBELER 12550 AURORA AVE N SEATTLE WA 98133 13061087 0 X WWW.PROVAIL.ORG X 1942 WA PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 14 14 409 450 2361 1361 7834091 9197533 477894 465844 2421 5518 602440 586469 8916846 10255364 0 0 0 0 7701291 7651461 0 0 287524 1340738 1338294 9042029 8989755 -125183 1265609 3154085 8123548 2222017 5925871 932068 2197677 PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 0 0 1014318 465844 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 380 CLIENTS ARE SERVED EACH YEAR. IN ADDITION, THE DENTAL CLINIC PROVIDES PROFESSIONAL DENTAL SERVICES TO PEOPLE WITH DISABILITIES, SERVING APPROXIMATELY 225 CLIENTS EACH YEAR. 1321077 452199 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 225 CLIENTS. WE OPERATE A LIGHT MANUFACTURING FACILITY THAT PROVIDES EMPLOYMENT AND VOCATIONAL SERVICES FOR APPROXIMATELY 24 PERSONS WITH DISABILITIES IN AN INTEGRATED, COMPETITIVE WORKPLACE. 5328772 COMMUNITY LIVING SERVICES - PROVIDES SUPPORTED LIVING SERVICES TO ADULTS WITH SEVERE DEVELOPMENT 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. 7664167 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 12 0 1 409 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 14 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 WA X KELLY RONDOU 2063637303 12550 AURORA AVE N SEATTLE WA 98133 KEN TOOLE 1.00 X X 0 0 0 KATIE CISSELL 1.00 X X 0 0 0 JEANA JORGENSEN 1.00 X X 0 0 0 CARLY LIST 1.00 X X 0 0 0 DEREK CRUMP 1.00 X X 0 0 0 DOUG MCFARLAND 1.00 X X 0 0 0 JIM CHESEMORE 1.00 X 0 0 0 JENNY COCHRANE 1.00 X 0 0 0 DOUG DURBIN 1.00 X 0 0 0 JARED HAGER 1.00 X 0 0 0 CHRIS KING 1.00 X 0 0 0 KEVIN KOPPES 1.00 X 0 0 0 SKYLAR SHERWOOD 1.00 X 0 0 0 BART WILSON 1.00 X 0 0 0 MICHAEL HATZENBELER 40.00 X 124689 0 13841 JAMES MACKELLAR-HERTAN 40.00 X 99258 0 8965 ALEXANDER GIBB 40.00 X 111057 0 13841 335004 0 36647 2 0 0 0 0 107558 179588 8585919 324468 9197533 REHABILITATION & DENTAL 900099 385500 385500 TRAUMATIC BRAIN INJURY CLINIC 900099 80344 80344 465844 768 768 21959 5725 19329 0 2630 5725 8355 2361 5994 4750 0 4750 4750 4750 57943 179588 90920 -32977 -32977 3147673 2695474 452199 452199 EARLY LEASE TERMINATION REVENUE 900099 131627 131627 MISCELLANEOUS 900099 26483 26483 LAUNDRY INCOME 900099 782 782 158892 10255364 918043 2361 137427 X 265338 234358 25263 5717 6192587 5468875 586700 137012 490596 433962 49449 7185 702940 634220 44858 23862 72221 67005 5216 170717 90189 44694 35834 24532 7973 895 15664 173434 157935 8826 6673 200432 145826 48689 5917 127965 125799 1504 662 39704 22205 16744 755 116152 68259 45109 2784 89299 43460 44957 882 80244 59610 19564 1070 GENERAL AND ADMINISTRAT 97397 51950 32464 12983 DUES & SUBSCRIPTIONS 67153 11612 55479 62 TAXES, LICENSES AND FEE 44717 36384 7653 680 FUNDRAISING EXPENSES 34327 4545 29782 8989755 7664167 1038064 287524 102881 402334 371101 68804 1776876 1820592 111481 155871 101026 70707 7224307 1729595 560009 5494712 87663 87663 43048 22865 3154085 8123548 947796 1102734 1081955 4773503 192266 49634 2222017 5925871 X 932068 2197677 932068 2197677 3154085 8123548 1265609 0 X X 0 1 X 1 0 X 8005524 7862553 7865773 7834091 9197533 40765474 8005524 7862553 7865773 7834091 9197533 40765474 40765474 6919 6925 7343 2421 768 24376 5515 3970 14215 77489 158892 260081 41049931 6376407 0.99310 0.99610 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3263030 3263030 2370357 440965 1929392 614566 424243 190323 976354 864387 111967 5494712 DEFERRED RENT 49634 49634 GOLF TOURNAMENT 163477 112784 50693 2090 29520 18081 17305 LUNCHEON 67707 61457 6250 6063 9372 3755 2 6347 5347 1000 1995 2739 237531 179588 57943 2090 35583 29448 23799 90920 -32977 PATRICIA TOOLE SPOUSE OF A BOARD MEMBER 27836 PATRICIA IS EMPLOYED BY PROVAIL AS AN OCCUPATIONAL THERAPIST. 0 FORM 990, PART VI, SECTION A, LINE 4 UPDATED OUR OFFICIAL NAME CHANGE TO PROVAIL THAT WAS ORIGINALLY CHANGED IN 1998 BUT THE BY-LAWS WERE NOT CORRECTLY AMENDED AND WE DISCOVERED THIS DURING THIS FISCAL YEAR AND MADE THE CORRECTION. 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 UNDERTOOK THE EVALUATION AND COMPENSATION SETTING FOR THE CEO. THEY COMPLETED THE EVALUATION PORTION GETTING INPUT FROM THE BOARD OF DIRECTORS AND EMPLOYEES SUPERVISED BY THE CEO. THEY ALSO REVIEWED SALARIES AT COMPARABLE AGENCIES BY PULLING 990'S FROM 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. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 20,976. MANAGEMENT AND GENERAL EXPENSES 5,368. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,344. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 69,213. MANAGEMENT AND GENERAL EXPENSES 39,326. FUNDRAISING EXPENSES 35,834. TOTAL EXPENSES 144,373. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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 N/A 0 AUBURN COMMUNITY LIVING 12550 AURORA AVE N SEATTLE WA 98133 911814582 COMMUNITY HOUSING WA 501(C)(3) 7 N/A 0 EASTSIDE COMMUNITY LIVING 12550 AURORA AVE N SEATTLE WA 98133 943206977 COMMUNITY HOUSING WA 501(C)(3) 7 N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0