2024-04-15T14:32:04-05:00 2022-06-30 910189318 MOSS ADAMS LLP 999 THIRD AVENUE SUITE 2800 SEATTLE WA 98104 990 2021-07-01 910593488 PROVAIL PROV 2063637303 12550 AURORA AVE N SEATTLE WA 98133 MICHAEL J HATZENBELER CEO 2063637303 2024-04-12 1 MICHAEL HATZENBELER 999009999 EMINA O CRESSWELL CPA P01217304 2063026500 2024-04-12 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z X MICHAEL J HATZENBELER 12550 AURORA AVE N SEATTLE WA 98133 24125025 0 X WWW.PROVAIL.ORG X 1942 WA PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 16 16 544 50 1145 0 20221486 23120227 725692 944081 243 167 -26509 -76302 20920912 23988173 0 0 0 0 17411076 18424796 14533 0 71312 1945878 4054925 19371487 22479721 1549425 1508452 17228128 17311640 8844224 7646538 8383904 9665102 PROVAIL'S MISSION IS TO SUPPORT PEOPLE WITH DISABILITIES TO FULFILL THEIR LIFE CHOICES. 0 0 13022607 880258 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 75 CLIENTS ARE SERVED. ADDITIONALLY, WE OPENED OUR BRAINSPACE BOARDING HOME FOR SURVIVORS OF TRAUMATIC BRAIN INJURY IN FEBRUARY 2017 WITH SPACE TO SERVE 12 BOARDERS WITH A CURRENT 75 BOARDER STATUS. 4291960 63823 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 415 CLIENTS. 1435843 0 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 100 CLIENTS WERE SERVED THIS YEAR. 18750410 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 0 1 544 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 0 X STEPHEN ROSSI 2068261024 12550 AURORA AVE N SEATTLE WA 98133 DENISE KAJANOFF IMMEDIATE PAST CHAIR 1.00 1.00 X X 0 0 0 STEVE SUTER 2ND VICE CHAIR 1.00 1.00 X X 0 0 0 TERRIE DEIDESHEIMER CHAIR 1.00 1.00 X X 0 0 0 MIKE HUGHES TREASURER 1.00 1.00 X X 0 0 0 TERRI SUTTON 1ST VICE CHAIR 1.00 1.00 X X 0 0 0 DALE DEWITT SECRETARY 1.00 1.00 X X 0 0 0 JIM CHESEMORE DIRECTOR 1.00 X 0 0 0 DON BLACK DIRECTOR 1.00 X 0 0 0 WHITNEY KEYES DIRECTOR 1.00 X 0 0 0 ALESHA MORGAN MARTINEZ DIRECTOR 1.00 X 0 0 0 AMANDA VAN HOOK DIRECTOR 1.00 X 0 0 0 JIM MITCHELL DIRECTOR 1.00 X 0 0 0 ROLAND DEEX DIRECTOR 1.00 X 0 0 0 MICHAEL KUROMI DIRECTOR 1.00 X 0 0 0 ASHLEY STUDERUS DIRECTOR 1.00 X 0 0 0 BRANDON CHISOLM DIRECTOR 1.00 X 0 0 0 JASON PETERSON DIRECTOR (THRU 01/2022) 1.00 X 0 0 0 DOUGLAS BOWES DIRECTOR (THRU 05/2022) 1.00 X 0 0 0 HEALTH ALDER DIRECTOR (THRU 07/2021) 1.00 X 0 0 0 MARILYN HALL DIRECTOR (THRU 08/2022) 1.00 X 0 0 0 MICHAEL HATZENBELER CEO 40.00 1.00 X 214933 0 14284 BEN ROBINSON CFO 40.00 1.00 X 157075 0 0 372008 0 14284 2 0 1 0 0 183484 22611688 325055 11410 23120227 THERAPEUTIC CLINIC 621400 737439 737439 EMPLOYMENT SERVICES 561300 63823 63823 142819 142819 944081 167 167 51650 56964 -5314 -5314 1145 -6459 8900 183484 79888 -70988 -70988 23988173 944081 1145 -77280 398228 371943 26285 15553134 14173645 1379489 1008306 947808 60498 1465128 1358527 106601 10743 10743 16316 16316 118927 118927 737359 172906 541217 23236 17795 332 12263 5200 485918 176247 309671 394264 46937 347327 391257 256587 134670 68990 67605 1385 2757 2757 1699 456 1243 18715 18715 268731 138675 130056 91788 91788 REPAIRS & JANITORIAL 152853 97719 55134 OPEN JOB LISTINGS 105116 1698 103040 378 FOOD & APPRECIATION 28203 23890 4238 75 BOARD EXPENSES 10210 10210 1133284 883220 207641 42423 22479721 18750410 3657999 71312 7083543 7541940 62292 62323 1916788 1867550 186160 19155 9622742 1923893 7877700 7698849 87663 0 0 109935 13982 11888 17228128 17311640 1185185 2132625 131860 3173 5621064 5510740 1906115 0 8844224 7646538 X 8268816 9622502 115088 42600 8383904 9665102 17228128 17311640 1508452 -227254 0 X 0 1 X 1 0 X 12830097 15347756 18547491 20221486 23129127 90075957 12830097 15347756 18547491 20221486 23129127 90075957 90075957 70832 72788 75951 81456 51817 352844 12538 12118 5727 30383 17479 58622 23362 333 99796 90558980 0.99470 0.99690 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - LAUNDRY INCOME LEASE DEPOSIT REFUND OTHER - 2017 AMOUNT: $ 17,479. 2018 AMOUNT: $ 58,622. 2019 AMOUNT: $ 23,362. 2020 AMOUNT: $ 333. 2021 AMOUNT: $ 0. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3146359 3146359 5684448 1430847 4253601 297645 93158 204487 446243 399888 46355 48047 48047 7698849 X PART X, LINE 2: PROVAIL (INCLUDING THE BURKE-GILMAN APARTMENTS) AND PROVAIL AFFILIATES (EASTSIDE COMMUNITY LIVING, AND AUBURN COMMUNITY LIVING) ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS INCOME AS DEFINED UNDER IRC SECTION 511 THROUGH 515. ALL ARE ALSO EXEMPT FROM CERTAIN EXCISE TAXES AND REAL ESTATE PROPERTY TAXES ON CERTAIN BUILDINGS. PROVAIL FOLLOWS FASB (FINANCIAL ACCOUNTING STANDARDS BOARD) ASC 740-10, INCOME TAXES, RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS. ASC 740-10 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR ACCOUNTING FOR UNCERTAIN TAX POSITIONS AND ALSO PROVIDES GUIDANCE ON VARIOUS RELATED MATTERS SUCH AS DERECOGNITION, INTEREST, PENALTIES AND DISCLOSURES REQUIRED. MANAGEMENT DOES NOT BELIEVE PROVAIL HAS AN UNCERTAIN TAX POSITION AS OF AND FOR THE YEAR ENDED JUNE 30, 2022. GOLF TOURNAMENT 192384 183484 8900 79888 192384 183484 8900 79888 79888 -70988 X X X 0 0 0 0 0 0 0 1 0 MICHAEL HATZENBELER CEO 185364 0 29569 0 0 0 0 0 14284 0 229217 0 0 0 BEN ROBINSON CFO 157075 0 0 0 0 0 0 0 0 0 157075 0 0 0 PART I, LINE 7 THE CEO'S BONUS IS DETERMINED BASED ON FOUR PERFORMANCE FACTORS, ONE OF WHICH BEING THE ORGANIZATION'S NET EARNINGS COMPARED TO BUDGET. THE AMOUNT OF NET INCOME DOES NOT DIRECTLY DETERMINE ANY AMOUNT OF THE PERFORMANCE BONUS. THE OTHER PERFORMANCE FACTORS ARE BASED ON INDIVIDUAL PERFORMANCE AND THE ORGANIZATION'S FINANCIAL POSITION. THE AMOUNT IS DETERMINED BY THE BOARD AND IS LIMITED TO 25% OF THE CEO'S BASE COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION GENERALLY PROVIDES A DRAFT COPY OF THE FORM 990 TO THE GOVERNING BOARD AND REQUESTS ANY QUESTIONS OR COMMENTS BE DIRECTED TO THE CFO. THE ORGANIZATION GENERALLY PROVIDES A DRAFT COPY OF THE FORM 990 TO THE MANAGEMENT OF THE ORGANIZATION AND REQUESTS ANY QUESTIONS OR COMMENTS BE DIRECTED TO THE CFO. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD GOVERNANCE COMMITTEE REVIEWS AND APPROVES THE CONFLICT OF INTEREST POLICY. 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. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD UNDERTAKES THE EVALUATION AND COMPENSATION SETTING FOR THE CEO. THEY COMPLETED THE EVALUATION PORTION BY GETTING INPUT FROM THE BOARD OF DIRECTORS AND EMPLOYEES SUPERVISED BY THE CEO. THEY ALSO REVIEWED SALARIES AT COMPARABLE AGENCIES VIA A COMPENSATION SURVEY PERFORMED BY ARCHBRIGHT, AN INDEPENDENT ORGANIZATION. 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. EACH YEAR WE PULL SALARY INFORMATION FROM ARCHBRIGHT WHICH COMPILES COMPREHENSIVE NON-PROFIT AND FOR-PROFIT SALARY INFORMATION FROM HUNDREDS OF COMPANIES AND NON-PROFITS IN THE PACIFIC NORTHWEST AND WE USE THAT SALARY INFORMATION TO INFORM PAY INCREASES AND WAGE RANGES FOR ALL POSITIONS AT PROVAIL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, BOX B, AMENDED RETURN: THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENT AUDIT WAS NOT YET ISSUED DURING THE PREPARATION OF THE ORIGINALLY FILED TAX RETURN. THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS IS NOW COMPLETE. THE FORM 990 IS BEING AMENDED TO REPORT THE FINAL AUDITED FINANCIAL STATEMENT AMOUNTS. UPDATES ARE INCLUDED IN PARTS I, III, VII, VIII, IX, X, XI, XII, SCHEDULE A, SCHEDULE J, AND SCHEDULE R OF FORM 990. PROVAIL - AFFILIATES KING & SNOHOMISH COUNTIES 12550 AURORA AVE N SEATTLE WA 98133 912146011 COMMUNITY HOUSING WA 501(C)(3) LINE 7 PROVAIL 1 AUBURN COMMUNITY LIVING 12550 AURORA AVE N SEATTLE WA 98133 911814582 COMMUNITY HOUSING WA 501(C)(3) LINE 7 PROVAIL 1 EASTSIDE COMMUNITY LIVING 12550 AURORA AVE N SEATTLE WA 98133 943206977 COMMUNITY HOUSING WA 501(C)(3) LINE 7 PROVAIL 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PROVAIL - AFFILIATES KING & SNOHOMISH COUNTIES D 131050 FMV