2011-03-14T17:41:09-05:00 2010-06-30 PETERSON SULLIVAN LLP CPA'S 601 UNION ST STE 2300 SEATTLE WA 981012345 990 2009-07-01 910593488 PROVAIL PROV 2063637303 12550 Aurora Ave N SEATTLE WA 98133 michael j hatzenbeler 2063637303 2011-03-08 1 Raymon G Holmdahl 2063827777 2011-03-08 2009 2016-02-24 21:20:13Z Michael J Hatzenbeler 12550 Aurora Ave N SEATTLE WA 98133 11445827 0 X WWW.PROVAIL.ORG X 1942 WA PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 14 14 379 360 0 0 8005524 7862553 651476 807375 6919 11025 507038 888486 9170957 9569439 0 0 7765223 7398184 0 239951 1444339 1561332 9209562 8959516 -38605 609923 2896455 3440380 2215599 2315068 680856 1125312 PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 0 0 1146493 807375 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. 957502 912973 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 140 clients. We operate a light manufacturing facility that provides employment and vocational services for approximately 30 persons with disabilities in an integrated, competitive workplace. 5598928 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 65 clients are served. 7702923 1 1 0 0 0 0 0 0 0 1 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 8 0 1 379 1 0 0 0 0 0 1 1 0 0 0 14 14 0 0 0 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 Doug McFarland 1.00 X X 0 0 0 Katie Cissell 1.00 X X 0 0 0 Carly List 1.00 X X 0 0 0 Ken Toole 1.00 X X 0 0 0 Jared Hager 1.00 X X 0 0 0 Jenny Cochrane 1.00 X 0 0 0 Derek Crump 1.00 X 0 0 0 Bob Frey 1.00 X 0 0 0 Jeana Jorgensen 1.00 X 0 0 0 Chris King 1.00 X 0 0 0 Nolan Newman CPA 1.00 X 0 0 0 Skylar Sherwood 1.00 X 0 0 0 Zoe Vinson 1.00 X 0 0 0 Randy Willett 1.00 X 0 0 0 Michael Hatzenbeler 40.00 X 113987 0 10531 Jerry Hynes 40.00 X 111626 0 6389 225613 0 16920 2 0 0 0 0 137693 135560 7456761 132539 7862553 REHABILITATION & DENTA 900099 704139 704139 traumatic brain injury 900099 103236 103236 807375 6925 6925 4100 4100 4100 4100 57945 135560 86402 -28457 -28457 2702959 1789986 912973 912973 cobra & misc receipts 900099 1779 1779 Miscellaneous 900099 1447 1447 laundry income 900099 744 744 3970 9569439 1720348 0 -13462 242533 213295 23082 6156 6112209 5390899 574504 146806 390578 330256 43312 17010 652864 578317 62743 11804 50253 31861 18088 304 119872 75996 43147 729 18706 4669 1762 12275 135301 113593 16650 5058 406376 273804 118778 13794 100473 99569 761 143 30202 21108 6108 2986 67660 63400 3544 716 98404 59074 38018 1312 67272 47142 19363 767 GENERAL AND ADMINISTRAT 414088 379789 29486 4813 DUES & SUBSCRIPTIONS 18365 6806 11559 TAXES, LICENSES AND FEE 16841 10968 5737 136 fundraising expenses 15142 15142 MISCELLANEOUS 2377 2377 8959516 7702923 1016642 239951 136536 201269 171626 743718 1635457 1545797 58577 38527 53157 68304 2273382 1569434 672687 703948 87663 87663 80752 51154 2896455 3440380 823197 935816 1233860 1196845 158542 182407 2215599 2315068 X 680856 1125312 680856 1125312 2896455 3440380 X 0 1 1 X 0 X 7902594 7792920 8104453 8005524 7862553 39668044 7902594 7792920 8104453 8005524 7862553 39668044 39668044 3454 11930 19730 6919 6925 48958 104671 10562 12751 5515 3970 137469 39854471 9565975 0.99530 0.99220 X Schedule A, Part II, Line 10, Explanation of Other Income: MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 70500 70500 614566 377407 237159 604431 359513 244918 983885 832514 151371 703948 FUNDS HELD IN TRUST FOR OTHERS 1709 Deferred Rent 180698 182407 Part X: No uncertain tax positions were addressed in the organizations financial statement footnotes. Luncheon 34658 26201 8457 500 14229 Golf Tournament 153046 103558 49488 71372 1 5801 5801 301 193505 135560 57945 500 85902 86402 -28457 trish toole spouse of a board member 27165 Trish 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 and management 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 filled 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 Board of directors 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 documents are available upon request. form 990, part xi, line 2c this process has not changed from the prior year. Provail - Affiliates 12550 aurora ave n seattle WA 98133 912146011 Community Housing WA 501(c)(3) 7 N/A auburn community living 12550 aurora ave n seattle WA 98133 911814582 Community Housing WA 501(c)(3) 7 N/A eastside community living 12550 aurora ave n seattle WA 98133 943206977 Community Housing WA 501(c)(3) 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0