2023-05-15T11:44:14-05:00 2022-06-30 FORVIS LLP 77 W UNIVERSITY DR MESA AZ 85201 990 2021-07-01 860892673 Los Ninos Hospital Inc % LAURA WORTHY LOSN 6022434231 1402 E South Mountain Avenue Phoenix AZ 85042 PERRY PETRILLI CEO 6022434231 2023-05-15 true Perry Petrilli 999009999 Jeffrey A Bither P01428424 4808346030 2021 2023-04-26 12:10:37Z PERRY PETRILLI 1402 E South Mountain Avenue Phoenix AZ 85042 14130207 false X WWW.HACIENDAINC.ORG/ X 1997 AZ TO CARE FOR MEDICALLY FRAGILE INFANTS, CHILDREN, TEENS AND ADULTS AT THEIR HOME. 5 5 42 5 0 0 1394459 10707 6059726 6307430 1106962 663638 0 0 8561147 6981775 3561441 3204463 0 0 3361284 3465623 0 0 0 2593076 2786909 9515801 9456995 -954654 -2475220 9129705 5590578 802458 788821 8327247 4801757 X TO CARE FOR MEDICALLY FRAGILE INFANTS, CHILDREN, TEENS AND ADULTS AT THEIR HOME. false false 3672056 3204463 2586046 HOME HEALTH CARE: HOME HEALTH CARE SPECIALIZES IN THE CARE OF INFANTS, CHILDREN AND ADULTS WITH SPECIAL HEALTH CARE NEEDS REQUIRING HOME HEALTH CARE FROM NURSES AND THERAPISTS WITH SPECIAL TRAINING. 5284178 3721384 VENTILATOR PROGRAM: THE VENTILATOR PROGRAM ENABLES VENTILATOR DEPENDENT INDIVIDUALS TO FUNCTION IN SOCIETY AT THE OPTIMAL LEVEL OF THEIR CAPABILITIES AND POTENTIAL BY COMBINING TECHNOLOGY, SERVICES AND MEDICAL SUPPLIES. THIS IS ACHIEVED BY PROVIDING PRODUCTS, EDUCATION, TRAINING AND ON-GOING MONITORING OF EQUIPMENT. THE VENTILATOR PROGRAM PROVIDES SERVICE ON VENTILATORS AND OTHER MEDICAL EQUIPMENT IN PATIENTS' HOMES, AS WELL AS A HOME ENTERAL FEEDING SERVICE THAT SERVES THE NUTRITIONAL NEEDS OF MEDICALLY FRAGILE PATIENTS BY PROVIDING FORMULA AND SUPPLIES. ENTERAL SERVICES: THE ENTERAL PROGRAM SERVES THE NUTRITIONAL NEEDS OF MEDICALLY FRAGILE PATIENTS BY PROVIDING FORMULA AND SUPPLIES. 8956234 true false false false false false false false false false true false false false false true true false false false false false false false false false false true false true false false false false false false false false false false false false false true true true false false true 8 0 true 42 true false false false false false false false false false false false false X 5 5 false false false false false false false true true false false true true true true true true true true false X LAURA WORTHY 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 X PERRY PETRILLI CEO 4.0 36.0 X 0 248030 0 LAURA WORTHY CHIEF FINANCIAL OFFICER 4.0 36.0 X 0 182310 2526 JOHN WIDDER HOME MEDICAL ADMINISTRATOR 40.0 0.0 X 140831 0 0 LINDA STILLMAN DIRECTOR OF HUMAN RESOURCES 4.0 36.0 X 0 135758 4080 CASSANDRA KAAUA CLINICAL SERVICES DIRECTOR 40.0 0.0 X 118263 0 0 PETER NICOLA DIRECTOR OF IT 40.0 0.0 X 0 102524 0 GARY ORMAN BOARD PRESIDENT 1.0 1.0 X X 0 0 0 GEORGE SABOL BOARD VICE PRESIDENT 1.0 1.0 X X 0 0 0 JANET WEIGEL SECRETARY 1.0 1.0 X X 0 0 0 MIKE WADE TREASURER 1.0 1.0 X X 0 0 0 ALEXANDER RYAN BOARD MEMBER 1.0 1.0 X 0 0 0 259094 668622 6606 2 false true false NONE 0 10707 10707 PRIVATE PATIENT REVENUE 623990 4540656 4540656 GOVERNMENT PATIENT REVENUE 623990 1689198 1689198 VENT EQUIPMENT RENTAL INCOME 623990 57150 57150 OTHER INCOME 623990 20426 20426 6307430 83026 83026 0 0 0 0 0 7729044 7148432 580612 580612 580612 0 0 0 0 0 0 0 0 0 0 6981775 6307430 663638 3204463 3204463 0 0 0 0 0 2871388 2721766 149622 75250 75250 325373 293045 32328 193612 193612 0 165175 165175 42703 42703 0 0 14611 14611 74943 74943 1823 1823 13049 11992 1057 38324 38324 0 79389 79389 81 81 0 0 10 10 0 197018 197018 254350 188888 65462 Plan Fees 3326 3326 Fleet 46587 46587 Equipment Expense 212294 212294 Supplies 1596785 1596785 46441 16638 29803 9456995 8956234 500761 0 154212 349372 353149 1265008 0 0 1127779 1768351 0 0 0 0 0 0 62913 111908 4428 7710 2008820 1582865 526505 425955 6900719 1662274 0 0 0 0 0 0 0 0 9129705 5590578 802458 659929 0 0 0 0 0 0 0 0 0 0 0 0 0 128892 0 0 802458 788821 X 8327247 4801757 0 0 8327247 4801757 9129705 5590578 -2475220 -1050270 X false true X true false X 115315 1213522 1400627 1394459 10707 4134630 7267633 6780723 6512431 6059727 6307430 32927944 0 0 0 7382948 7994245 7913058 7454186 6318137 37062574 0 0 0 37062574 180139 94188 45145 35201 83026 437699 0 180139 94188 45145 35201 83026 437699 0 0 7563087 8088433 7958203 7489387 6401163 37500273 0.98833 0.98080 0.01167 0.01020 X 2008820 1582865 425955 425955 0 0 X 5916894 -1050270 -1050270 6967164 14611 14611 6981775 9442384 9442384 14611 14611 9456995 SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: THE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE IRC) AND SIMILAR STATE PROVISIONS. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE MAY BE SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A)(III) OF THE IRC AND HAS BEEN CLASSIFIED AS AN ORGANIZATION OTHER THAN A PRIVATE FOUNDATION UNDER SECTION 509(A)(1) OF THE IRC. THE ORGANIZATION HAS PROVIDED FOR INCOME TAXES ON ITS UNRELATED BUSINESS INCOME, WHICH HAVE NOT BEEN SIGNIFICANT, AS REQUIRED BY SECTION 512 OF THE CODE. THE ORGANIZATION ACCOUNTS FOR THE EFFECT OF ANY UNCERTAIN TAX POSITIONS BASED ON WHETHER IT IS "MORE-LIKELY-THAN-NOT" THAT THE POSITION WILL BE SUSTAINED BY THE TAXING AUTHORITY UPON EXAMINATION. THE ORGANIZATION ROUTINELY EVALUATES POTENTIAL UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAS IDENTIFIED ITS STATUS AS AN EXEMPT ORGANIZATION AS A TAX POSITION; HOWEVER, THE ORGANIZATION HAS DETERMINED THAT SUCH TAX POSITION DOES NOT RESULT IN AN UNCERTAINTY THAT REQUIRES RECOGNITION. THE ORGANIZATION FILES INFORMATIONAL AND INCOME TAX RETURNS IN THE US FEDERAL JURISDICTION AND THE STATE OF ARIZONA. AS OF JUNE 30, 2022, US FEDERAL INFORMATIONAL AND INCOME TAX RETURNS FOR THE three most recent years open to assessment. Interest and penalties, if any, are accrued as a component of management and general expenses when assessed. true Hacienda Inc 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860253158 501(C)(3) 3204463 TO FULFILL THE ORGANIZATION'S CHARITABLE PURPOSE 1 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING GRANT FUNDS: THE RELATED ORGANIZATIONS' GOVERNING BOARDS MONITOR THE USE OF GRANTS BETWEEN RELATED ENTITIES. X X X false false false false false false false false false PERRY PETRILLI CEO 0 214762 0 0 0 33268 0 0 0 0 0 248030 LAURA WORTHY CHIEF FINANCIAL OFFICER 0 158288 0 0 0 24022 0 0 0 2526 0 184836 SCHEDULE J, PART I, LINE 3 THE HACIENDA HEALTHCARE BOARD OF DIRECTORS APPROVES CHANGES IN EXECUTIVE COMPENSATION ANNUALLY BEFORE THE CHANGES TAKE PLACE. THE ANNUAL EXECUTIVE COMPENSATION COMPARABILITY DATA STUDY AND THE BOARD OF DIRECTORS' APPROVAL OF EXECUTIVE COMPENSATION ARE THOROUGHLY DOCUMENTED. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990: THE ORGANIZATION'S BOARD TREASURER, CEO AND CONTROLLER WILL REVIEW AND APPROVE THE FORM 990 PRIOR TO FILING. THEY WILL THEN REVIEW THE FINAL FORM 990 WITH THE ENTIRE BOARD. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT ADDRESSES THE CONSIDERATION OF POTENTIAL CONFLICTS OF INTEREST BY THE BOARD OF DIRECTORS, COMMITTEE MEMBERS, KEY EMPLOYEES, AND THEIR RELATIVES. AS PER THE POLICY, SUCH PERSONS MUST MAKE DISCLOSURE OF ANY POTENTIAL CONFLICTS OF INTEREST AND MUST ABSTAIN FROM VOTING ON ANY ACTION IN WHICH THEY MAY HAVE AN INTEREST. ON AN ANNUAL BASIS, ALL BOARD MEMBERS ARE REQUIRED TO SIGN OFF ON AN ANNUAL CONFLICT OF INTEREST FORM, EITHER STATING ANY KNOWN CONFLICTS, OR STATING THAT THERE ARE NONE. FORM 990, PART VI, SECTION B, LINE 15A & 15B PROCESS FOR DETERMINING COMPENSATION: THE BOARD OF DIRECTORS DETERMINES REASONABLE AND APPROPRIATE SALARIES FOR KEY EMPLOYEES OF THE ORGANIZATION BY EXAMINING COMPETITIVE SALARIES. INCREASES ARE ALSO BASED ON PERFORMANCE OF THE EXECUTIVES AND BASED ON IMPORTANCE OF RESPONSIBILITIES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS MADE AVAILABLE TO THE PUBLIC: THE ORGANIZATION GENERALLY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII COMPENSATION FROM RELATED PARTIES: LOS NINOS HOSPITAL, INC. IS RELATED TO ONE TAX EXEMPT AFFILIATE: HACIENDA, INC. THIS ORGANIZATION SHARES A COMMON MANAGEMENT TEAM WITH LOS NINOS HOSPITAL, INC. THE INDIVIDUALS ON THE MANAGEMENT TEAM ARE COMPENSATED AS EMPLOYEES BY HACIENDA, INC. THE COMPENSATION AMOUNTS LISTED IN PART VII ARE THE TOTAL GROSS WAGES AND OTHER COMPENSATION PAID TO THESE INDIVIDUALS FOR THEIR SERVICES TO ALL AFFILIATED ORGANIZATIONS. HACIENDA INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860253158 NURSING CARE AZ 501(C)(3) 10 NA true false true true false false false false false false false true true true true true true false true false Hacienda Inc B 3204463 CASH