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  5. RESIDENCE XII

RESIDENCE XII

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Company Details

Legal Name: RESIDENCE XII
Jurisdiction: WASHINGTON
Entity Type: WA NONPROFIT CORPORATION
Category: DOMESTIC ENTITY
Status: Merged
Formation/ Registration Date: September 26th 1979
Date of Dissolution: July 7th 2020
Expiration date: 30 Sep 2020
UBI Number: 600 404 207
FEIN Number: 91-1093433
Purpose: RESIDENCE XII PROVIDES INPATIENT AND OUTPATIENT TREATMENT FOR ALCOHOL AND DRUG DEPENDENT WOMEN AND THEIR FAMILIES.
ZIP code: 98034
City: Kirkland
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 12029 113TH AVE NE, KIRKLAND, WA, 98034, UNITED STATES

Contact Details

E-Mail: LFREGIN@RESIDENCEXII.ORG
lfregin@residencexii.org
Website: www.residencexii.org
Phone Number: +1 425-823-8844

Nature of Business

ADDICTION REHAB FACILITY

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Registered Agent Information

Name Role Address
LORI FREGIN Registered Agent RESIDENCE XII, 12029 113TH AVE NE, KIRKLAND, WA, 98034-0000, UNITED STATES

Key Officers & Management

Name Role Address
JO COTTLE Governing Person -
MAKAYLAA POWERS Governing Person -
MARY BLACKBURN Governing Person -
GREG PIANTANIDA Governing Person -
MAKAYLAA POWERS BOARD PRESIDENT 13380 122ND PL NE, KIRKLAND, WA, 98034-5418, UNITED STATES
MARY BLACKBURN BOARD VICE PRESIDENT 14423 SE 17TH ST, BELLEVUE, WA, 98007-6002, UNITED STATES
GREG PIANTANIDA BOARD TREASURER GP REALTY FINANCE, 12600 SE 38TH ST #103, BELLEVUE, WA, 98006, UNITED STATES
KELLI STRAND-DANIELS BOARD SECRETARY 4410 144TH AVE SE, BELLEVUE, WA, 98006-2323, UNITED STATES

Unique Entity ID

CAGE Code:
4ZDC9
UEI Expiration Date:
2018-11-02

Business Information

Corporate URL:
http://www.residencexii.org
Division Name:
RESIDENCE XII
Activation Date:
2017-11-02
Initial Registration Date:
2008-02-04

Commercial and government entity program

CAGE number:
4ZDC9
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2022-11-04
CAGE Expiration:
2022-11-03
CAGE Link:
View company profile on CAGE website

Contact Information

POC:
LORI A. FREGIN
Corporate URL:
http://www.residencexii.org

National Provider Identifier

NPI Number:
1942220868
Link:
View on NPI website

Authorized Person:

Name:
AMBER KILWINE
Role:
EXECUTIVE ASSISTANT
Phone:
4258238844

Taxonomy:

Selected Taxonomy:
324500000X - Substance Abuse Rehabilitation Facility
Is Primary:
Yes

Contacts:

Phone:
+1 425-823-8844
Fax:
4258202371

Form 5500 Series

Employer Identification Number (EIN):
911093433
Plan Year:
2019
Number Of Participants:
58
Sponsor's telephone number:
8007765944
File:
View File
Plan Administrator / Signatory:
LORI FREGIN(Plan administrator)
Plan Year:
2019
Number Of Participants:
34
Sponsor's telephone number:
8007765944
File:
View File
Plan Administrator / Signatory:
LORI FREGIN(Plan administrator)
Plan Year:
2018
Number Of Participants:
53
Sponsor's telephone number:
8007765944
File:
View File
Plan Administrator / Signatory:
LORI FREGIN(Plan administrator)
Plan Year:
2017
Number Of Participants:
58
Sponsor's telephone number:
4258238844
File:
View File
Plan Administrator / Signatory:
LORI FREGIN(Plan administrator)
Plan Year:
2016
Number Of Participants:
57
Sponsor's telephone number:
4258238844
File:
View File
Plan Administrator / Signatory:
LORI FREGIN(Plan administrator)

Trademarks

Serial Number:
74238632
Mark:
RESIDENCE XII
Status:
Registration cancelled because registrant did not file an acceptable d...
Mark Type:
Service Mark
Application Filing Date:
1992-01-21
Mark Drawing Type:
1 - TYPESET WORD(S) /LETTER(S) /NUMBER(S)
Mark Literal Elements:
RESIDENCE XII
USPTO Link:
View Trademark on United States Patent and Trademark Office Website

Goods And Services

For:
alcohol and drug rehabilitation
First Use:
1981-10-19
International Classes:
042 - Primary Class
Class Status:
SECTION 8 - CANCELLED

Labor Condition Applications

Case Number:
I-203-12003-168956
Program:
E-3 Australian
Job Title:
CHEMICAL DEPENDENCY COUNSELOR
SOC (ONET/OES) code:
21-1011
SOC (ONET/OES) occupation title:
Substance Abuse and Behavioral Disorder Counselors
Begin Date:
2012-04-13
End Date:
2014-04-12

Employment and Wage Information

Address:
KIRKLAND, WA
Wage Rate Paid to Nonimmigrant Workers:
$35,000
Per:
Year
Prevailing Wage Rate:
$30,597
Case Number:
I-203-10169-464245
Job Title:
CHEMICAL DEPENDENCY COUNSELOR
SOC (ONET/OES) code:
21-1011.00
SOC (ONET/OES) occupation title:
Substance Abuse and Behavioral Disorder Counselors
Begin Date:
2010-07-06
End Date:
2012-07-05

Employment and Wage Information

Address:
KIRKLAND, WA
Wage Rate Paid to Nonimmigrant Workers:
$32,000
Prevailing Wage Rate:
$29,203

Charity/Fundraiser/Trust

Registration Number:
1103961
Type:
CHARITABLE ORGANIZATION
Status:
Delinquent
Renewal Date:
2020-07-31

Financial History

Fiscal Begin Date:
2017-07-01
Fiscal End Date:
2018-06-30
Begin Assets:
$5,652,111.00
Revenue:
$3,672,264.00
Program Services:
$2,867,577.00
Expenses:
$3,421,821.00
End Assets:
$5,352,797.00
% To Program Services:
84%
Fiscal Begin Date:
2016-07-01
Fiscal End Date:
2017-06-30
Begin Assets:
$5,904,337.00
Revenue:
$3,178,378.00
Program Services:
$2,825,167.00
Expenses:
$3,370,800.00
End Assets:
$5,652,111.00
% To Program Services:
84%
Fiscal Begin Date:
2015-07-01
Fiscal End Date:
2016-06-30
Begin Assets:
$6,585,265.00
Revenue:
$2,595,507.00
Program Services:
$2,629,249.00
Expenses:
$3,158,565.00
End Assets:
$5,904,337.00
% To Program Services:
83%
Fiscal Begin Date:
2014-07-01
Fiscal End Date:
2015-06-30
Begin Assets:
$6,803,057.00
Revenue:
$2,816,715.00
Program Services:
$2,532,402.00
Expenses:
$3,012,443.00
End Assets:
$6,585,265.00
% To Program Services:
84%
Fiscal Begin Date:
2013-07-01
Fiscal End Date:
2014-06-30
Begin Assets:
$6,876,079.00
Revenue:
$2,803,961.00
Program Services:
$2,491,647.00
Expenses:
$2,909,754.00
End Assets:
$4,580,831.00
% To Program Services:
86%
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