2022-05-12T13:10:20-05:00 2021-06-30 860271207 SCHMIDT WESTERGARD & COMPANY PLLC 77 WEST UNIVERSITY DRIVE MESA AZ 852015830 990 2020-07-01 860253158 HACIENDA INC HACI 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 PERRY PETRILLI CEO 6022434231 2022-05-11 1 PERRY PETRILLI 999009999 JEFFREY A BITHER P01428424 4808346030 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z PERRY PETRILLI 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 24830586 0 X HTTPS://WWW.HACIENDAINC.ORG/ X 1970 AZ PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 2 2 451 1 0 0 11760904 8717959 17506724 16073335 8768 -19470 0 0 29276396 24771824 0 48341 0 0 15455755 15409911 0 0 0 6677943 5860341 22133698 21318593 7142698 3453231 18385069 14483649 16959510 9493890 1425559 4989759 X PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 0 1 12610718 48341 10053245 INTERMEDIATE CARE FACILITY: THE ORGANIZATION OPERATES A STATE OF THE ART FACILITY WHICH OFFERS THREE SPECIALIZED PROGRAMS. THE HOSPITAL-TO-HOME PROGRAM PROVIDES SHORT-TERM MEDICAL INTERVENTION TO SPEED RECOVERY AND TO ALLOW PATEINTS TO RETURN HOME AS QUICKLY AS POSSIBLE. THIS PROGRAM ALSO PROVIDES FAMILY MEMBERS AND OTHER CAREGIVERS THE TRAINING NEEDED TO CARE FOR THEIR CHILD AT HOME. THE RESPITE CARE PROGRAM PROVIDES SHORT-TERM CARE TO PATIENTS WHILE FAMILIES TAKE TIMEOUT OR ATTEND TO OTHER MATTERS. THE RESIDENTIAL CARE PROGRAM PROVIES LONG-TERM CARE FOR CHRONICALLY ILL PATIENTS SUCH AS MEDICAL AND THERAPEUTIC SERVICES, ON CAMPUS AND PUBLIC SCHOOL EDUCATION, SOCIAL AND RECREATIONAL ACTIVITIES, AND PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES. 5771253 5667933 GROUP HOMES, MEDICAL GROUP HOMES: THE ORGANIZATION OPERATES EIGHT GROUP HOMES IN THE COMMUNITY; FIVE THAT ARE MEDICAL FACILITIES AND TWO TRADITIONAL GROUP HOMES AND ONE INDIVIDUAL DESIGNED LIVING ARRANGEMENT IDLA HOME.THE TWO TRADITIONAL GROUP HOMES OFFER 24-HOUR SUPERVISION, THE TEACHING OF HABILITATION SKILLS, DAILY LIVING SKILLS AND INTEGRATION INTO THE COMMUNITY.IN ADDITION TO THE OPPORTUNITIES PROVIDED IN THE TRADITIONAL GROUP HOME SETTING, THE MEDICAL GROUP HOME FACILITIES OFFER AROUND-THE-CLOCK MEDICAL SUPERVISION BY LICENSED PRACTICAL NURSES AND SUPERVISION BY A REGISTERED NURSE. THE INDIVIDUALS IN THESE HOMES REQUIRE SPECIFIC MEDICAL SUPERVISION BY TRAINED PERSONNEL.THE AUTISM GROUP HOME IS AN INDEPENDENT LIVING PROGRAM FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDER (ASD). IN ADDITION TO THE OPPORTUNITIES PROVIDED IN THE TRADITIONAL GROUP HOME SETTING, INDIVIDUALS WITH ASD HAVE THE OPPORTUNITY TO EXPERIENCE SIX WORK ENVIRONMENTS WHICH INCLUDE DIETARY, HOUSEKEEPING, LAUNDRY, MAINTENANCE, LANDSCAPE, AND BUSINESS OPERATIONS. THE PROGRAM ASSISTS PARTICIPANTS IN LEARNING AND MASTERING THE PERSONAL AND INTERPERSONAL CHARACTERISTICS THAT ARE KEY FOR ALL INDIVIDUALS TO BE SUCCESSFUL IN THEIR CHOSEN PROFESSION. PARTICIPANTS ARE PROVIDED THE OPPORTUNITY TO EXPERIENCE AREAS OF EMPLOYMENT SO THEY CAN SELECT THE TYPE OF WORK THAT MOST INTERESTS THEM. THE PROGRAM PROVIDES PARTICIPANTS THE SKILLS AND KNOWLEDGE TO DEVELOP AND HONE WORK RELATED SKILLS NECESSARY TO SECURE GAINFUL EMPLOYMENT IN THE COMMUNITY IN THEIR SELECTED LINE OF WORK. AS PARTICIPANTS BECOME READY TO GRADUATE THEY WILL BE GIVEN ASSISTANCE IN SECURING POST-PROGRAM EMPLOYMENT WHICH WILL INCLUDE PROVIDING THEM WITH A LETTER OF RECOMMENDATION THAT SPECIFIES THE TRAINING RECEIVED AND THE SKILLS THEY POSSESS.INDEPENDENT LIVING: THE ORGANIZATION OPERATES AN INDIVIDUAL LIVING PROGRAM WHICH IS DESIGNED TO PROVIDE ASSISTANCE TO PEOPLE WHO LIVE INDEPENDENTLY IN THEIR OWN HOME. PEOPLE WHO ARE SUPPORTED IN THE IDLA PROGRAM RECEIVE SUPPORT BASED ON THEIR LEVEL OF NEED. INDIVIDUALS MAY NEED SUPPORT RANGING FROM AS FEW AS FIVE HOURS PER WEEK TO AS MANY AS FIFTY HOURS PER WEEK. MEMBERS OF THE IDLA PROGRAM RENT OR OWN THEIR HOME AND PAY THE COSTS ASSOCIATED WITH LIVING EXPENSES THROUGH WAGES THEY EARN WORKING IN THEIR JOBS. 518453 318677 THE ORGANIZATION OPERATES A DAY TREATMENT JOB AND TRAINING PROGRAM IN PHOENIX, ARIZONA FOR ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. 18900424 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 23 0 1 451 1 0 0 0 0 0 0 0 0 0 0 X 2 2 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X THE ORGANIZATION 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 DEBRA KULKAY DIRECTOR OF REVENUE CYCLE 40.00 X 122366 0 3145 LAURA WORTHY FINANCE DIRECTOR 40.00 X 150177 0 3153 LINDA STILLMAN DIRECTOR OF HUMAN RESOURCE 40.00 X 120852 0 4605 LORENA BOWERS DIRECTOR OF RESPIRATORY SERVICES 40.00 X 112427 0 4405 PERRY PETRILLI CEO 40.00 10.00 X X 237081 0 0 PETER NICOLA DIRECTOR IT 40.00 X 103101 0 2917 TERESA DUNLAP DIRECTOR OF NURSING, ICF 40.00 X 153462 0 3834 GARY ORMAN BOARD PRESIDENT 1.00 X 0 0 0 HEATHER TEAFORD RN 40.00 X 115357 0 4795 SIERRA WALLWORK KAMELA VP MARKETING/PR 40.00 X 113248 0 4720 JOON BAIK ADMINISTRATOR 40.00 X 111689 0 0 RONELLE DONGMO LPN 40.00 X 121455 0 6091 HEATHER MYERS SENIOR ACCOUNTANT 40.00 X 108825 0 2142 1570040 0 39807 12 0 1 0 JC SIBLEY CONSULTING LLC 3821 LS MANCHA LN DENTON TX 76205 ICF CONSULTING 526900 1 6965041 945983 806935 507535 8717959 GOVERNMENT PATIENT SERVICE REVENU 623990 16066277 16066277 MEALS INCOME 900099 7058 7058 16073335 14010 14010 25282 58762 -33480 -33480 -33480 24771824 16039855 0 14010 48341 48341 1131531 1131531 11346468 11010455 336013 345530 330725 14805 1724428 1522189 202239 861954 694900 167054 214043 214043 57705 57705 6130 6130 832673 830418 2255 21809 10938 10871 10016 2396 7620 40542 689 39853 796431 743285 53146 1896 1896 786633 751557 35076 987434 927752 59682 SUPPLIES 1292071 1267152 24919 EQUIPMENT EXPENSE 292824 247995 44829 FOOD 150455 150455 BAD DEBT EXPENSE 59900 59900 309779 301277 8502 21318593 18900424 2418169 0 5705359 281133 1415568 1491043 221813 159844 513983 477666 16968610 7129118 10263935 9839492 264411 2234471 18385069 14483649 1227073 1108229 61923 55093 15165613 7840613 504901 489955 16959510 9493890 X 1394647 4965251 30912 24508 1425559 4989759 18385069 14483649 3453231 110969 0 X 0 1 X 0 0 X 684047 395974 199071 11760904 8669618 21709614 23894872 24551025 20665536 17506724 16073335 102691492 24578919 24946999 20864607 29267628 24742953 124401106 18550 2500 3700 1750 2175 28675 0 18550 2500 3700 1750 2175 28675 124372431 6870 9327 8690 34936 14010 73833 6870 9327 8690 34936 14010 73833 74547 74547 24660336 24956326 20873297 29302564 24756963 124549486 0.99860 0.99840 0.00060 0.00050 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3200 3200 38279 35079 3200 41561 3282 38279 104076 54089 116604 41561 15942 299522 211388 104076 0 0 74000 74000 9128190 2423906 6704284 3659726 1821590 1838136 1845451 1639683 205768 2261243 1243939 1017304 9839492 DEFERRED COMPENSATION LIABILITY 249465 DEFERRED SEVERANCE 240490 489955 X 24768422 110969 -114371 -3402 24771824 0 24771824 21204222 0 21204222 114371 114371 21318593 PART X, LINE 2: 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 U.S. FEDERAL JURISDICTION. AS OF JUNE 30, 2021, U.S. FEDERAL INFORMATIONAL AND INCOME TAX RETURNS FOR THE THREE MOST RECENT YEARS. INTEREST AND PENALTIES, IF ANY, ARE ACCRUED AS A COMPONENT OF MANAGEMENT AND GENERAL EXPENSES WHEN ASSESSED. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE INCLUDED IN EXPENSES -59,900. INVESTMENT FEE INCLUDED IN EXPENSES -6,130. CONTRIBUTION TO HACIENDA SKILLED NURSING FACILITY, INC. -48,341. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE INCLUDED IN EXPENSES 59,900. INVESTMENT FEE INCLUDED IN EXPENSES 6,130. CONTRIBUTION TO HACIENDA SKILLED NURSING FACILITY, INC. 48,341. 1 HACIENDA SKILLED NURSING FACILITY INC 1402 EAST SOUTH MOUNTAIN AVE PHOENIX AZ 85042 141906233 501(C)(3) 48341 TO FULFILL THE ORGANIZATION'S CHARTIABLE PURPOSE 1 PART I, LINE 2: THE RELATED ORGANIZATIONS' GOVERNING BOARDS MONITOR THE USE OF GRANTS BETWEEN RELATED ENTITIES X X X 0 0 0 0 0 0 0 0 0 PERRY PETRILLI CEO 237081 0 0 0 0 0 0 0 0 0 237081 0 0 0 TERESA DUNLAP DIRECTOR OF NURSING, ICF 153462 0 0 0 0 0 0 0 3834 0 157296 0 31 0 LAURA WORTHY FINANCE DIRECTOR 150177 0 0 0 0 0 0 0 3153 0 153330 0 0 0 PART I, LINE 3 HACIENDA HEALTHCARE COMPLETES AN ANNUAL EXECUTIVE COMPENSATION COMPARABILITY DATA STUDY TO ENSURE THAT THE VALUE OF THE SERVICES PROVIDED BY ITS EXECUTIVES IS COMMENSURATE WITH THEIR COMPENSATION. THIS ANNUAL PROCESS DOCUMENTS HOW IMPORTANT THIS MATTER IS TO HACIENDA HEALTHCARE. IN ARIZONA MOST NON-PROFIT ORGANIZATIONS ONLY DO AN EXECUTIVE COMPENSATION ANALYSIS EVERY 3-5 YEARS WITH EVERY 3 YEARS BEING THE AUDITORS' RECOMMENDATION AND EVERY 5 YEARS BEING ACCEPTABLE. THE REASON THAT HACIENDA HEALTHCARE DOES ANNUAL EXECUTIVE COMPENSATION COMPARABILITY DATA STUDIES IS BECAUSE THE ALREADY COMPLEX AND MULTI-FACETED SERVICE DELIVERY SYSTEM CONTINUES TO GROW. HACIENDA HEALTHCARE IS A COMPLEX, MULTI-FACETED HEALTH CARE AND SOCIAL SERVICE DELIVERY SYSTEM THAT PROVIDES 4 PROGRAMS THROUGHOUT THE STATE OF ARIZONA, MANY OF WHICH ARE ONE-OF-A-KIND. THUS, A THREE COMPONENT EXECUTIVE COMPENSATION COMPARABILITY DATA STUDY IS USED. IT INCLUDES TWO SALARY/PAYROLL WEBSITES AND A THOROUGH COMPENSATION COMPARABILITY STUDY USING 990'S FROM APPROXIMATELY 50 NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS THAT SHARE A NUMBER OF COMMON VARIABLES WITH HACIENDA HEALTHCARE. WE CONSIDERED THE UTILIZATION OF REBUTTABLE PRESUMPTION STUDIES AS ANOTHER WAY TO DETERMINE APPROPRITAE EXECUTIVE COMPENSATION. WE DETERMINED THAT A COMPARABLE ORGANIZATION WOULD HAVE TO BE SIMILAR TO HACIENDA HEALTHCARE IN 12 WAYS IN ORDER TO BE VALID. WE REQUESTED THE NAMES OF SEVERAL COMPANIES THAT PERFORM REBUTTABLE PRESUMPTION STUDIES. WE WERE PROVIDED FOUR NAMES. NONE OF THE COMPANIES WE CONTACTED WERE WILLING TO CONTRACT WITH HACIENDA HEALTHCARE SINCE THEY DID NOT FEEL THEY COULD MEET THE 12 CATEGORIES REQUIREMENT. 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. X 4 249900 COST X 30060 257635 COST 0 0 0 FORM 990, PART III, LINE 3 DUE TO COVID CONCERNS, MANY NEW PROCEDURES WERE PUT INTO PLACE TO PROTECT EMPLOYEES AND CLIENTS INCLUDING THE ADDITION OF AN ISOLATION WARD, COMMITTEE, CLEANING PROCEDURES, ADDITIONAL PPE, SANITATION EQIPMENT, ADMITTANCE OF OUTSIDE PERSONS, DAILY TEMPURTURE CHECKS AND TESTING. DTA AND TRANSPORTATION TO OUTSIDE ENTITIES CEASED DURING PEAK MONTHS AND ADMINISTRATIVE EMPLOYEES WENT REMOTE. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CEO WILL REVIEW AND APPROVE THE FORM 990 PRIOR TO FILING. THE ORGANIZATION'S CEO HAS BEEN AUTHORIZED BY THE BOARD OF DIRECTORS TO SIGN THE FINAL FORM 990. FORM 990, PART VI, SECTION B, LINE 12C 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 15 THE BOARD OF DIRECTORS DETERMINES REASONABLE AND APPROPRIATE SALARIES FOR KEY EMPLOYEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION GENERALLY DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. LOS NINOS HOSPITAL INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860892673 NON-PROFIT CHILDREN'S HOSPITAL AZ 501(C)(3) LINE 3 N/A 0 HACIENDA SKILLED NURSING FACILITY INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 141906233 NURSING CARE & RESPIRATORY INTERVENTION AZ 501(C)(3) LINE 10 N/A 0 HACIENDA CHILDRENS HOSPITAL INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 473035370 NON-PROFIT CHILDREN'S HOSPITAL AZ 501(C)(3) LINE 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 1