HACIENDA INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- HACIENDA INC (EIN 86-0253158)
- Tax period
- 2018-07-01 to 2019-06-30
- Filed
- 2020-08-31
- IRS object ID
- 202032449349301623
- Schema version
- 2018v3.2
- Note
- A later return for the same period supersedes this one.
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-08-31T15:03:59-05:00 | ReturnTs |
| Tax Period End | 2019-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 860271207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCHMIDT WESTERGARD & COMPANY PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 77 WEST UNIVERSITY DRIVE | AddressLine1Txt |
| City | MESA | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 852015830 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860253158 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HACIENDA INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HACI | BusinessNameControlTxt |
| Phone | 6022434231 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1402 E SOUTH MOUNTAIN AVENUE | AddressLine1Txt |
| City | PHOENIX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85042 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PERRY PETRILLI | PersonNm |
| Person Title | INTERIM CEO | PersonTitleTxt |
| Phone | 6022434231 | PhoneNum |
| Signature | 2020-08-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFFREY A BITHER | PreparerPersonNm |
| PTIN | P01428424 | PTIN |
| Phone | 4808346030 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.27.213.138 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-08-31 | IPDt |
| IP Tm | 12:14:36 | IPTm |
| IP Timezone | MS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 7394AA94C9A7FD3CE8BD2126D65D769B8B7F5BB4 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 7407511015FCE34E7FE0015C7B8225BB6A28E7B5 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-11-19 02:30:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | PERRY PETRILLI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1402 E SOUTH MOUNTAIN AVENUE | AddressLine1Txt |
| City | PHOENIX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $21,483,598 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.HACIENDAINC.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 660 | TotalEmployeeCnt |
| Total Volunteers | 3 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $395,974 | PYContributionsGrantsAmt |
| CY Contributions Grants | $199,071 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $24,551,025 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,665,536 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,509 | PYInvestmentIncomeAmt |
| CY Investment Income | -$961,188 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $24,953,508 | PYTotalRevenueAmt |
| CY Total Revenue | $19,903,419 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $35,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,801,527 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,497,545 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,871,367 | PYOtherExpensesAmt |
| CY Other Expenses | $7,182,704 | CYOtherExpensesAmt |
| PY Total Expenses | $24,707,894 | PYTotalExpensesAmt |
| CY Total Expenses | $24,680,249 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $245,614 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,776,830 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,037,830 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,438,560 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,032,060 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,270,697 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,005,770 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,167,863 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,803,658 | ExpenseAmt |
| Revenue | $12,169,597 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,264,003 | ExpenseAmt |
| Revenue | $6,141,411 | RevenueAmt |
| Desc | 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.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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,923,386 | ExpenseAmt |
| Revenue | $1,119,846 | RevenueAmt |
| Desc | THE ORGANIZATION OPERATES A DAY TREATMENT JOB AND TRAINING PROGRAM IN PHOENIX, ARIZONA FOR ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $231,270 | ExpenseAmt |
| Revenue | $260,497 | RevenueAmt |
| Desc | 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 COST SASSOCIATED WITH LIVING EXPENSES THROUGH WAGES THEY EARN WORKING IN THEIR JOBS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $231,270 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $260,497 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $20,222,317 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 40 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 660 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6022434231 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1402 E SOUTH MOUNTAIN AVENUE | AddressLine1Txt |
| City | PHOENIX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85042 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| GARY ORMAN | ||||||||
| EXECUTIVE VICE PRESIDENT | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JANET LOVELADY | ||||||||
| DIRECTOR OF NURSING | 40.00 | 0.00 | Yes (X) | Yes (X) | $126,003 | $0 | $0 | |
| JIM GERDES | ||||||||
| BOARD MEMBER | 0.50 | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| KATHRYN DEL REAL | ||||||||
| VICE PRESIDENT | 40.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KEVIN BERGER | ||||||||
| BOARD MEMBER | 0.50 | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| MIKE WADE | ||||||||
| SECRETARY | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PATRICK WHITE | ||||||||
| ACTING CEO | 40.00 | 1.50 | Yes (X) | $140,096 | $0 | $1,316 | ||
| RALPH WALLWORK | ||||||||
| TREASURER | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THOM NIEMIEC | ||||||||
| BOARD MEMBER | 0.50 | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| TOM POMEROY | ||||||||
| PRESIDENT | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NANCY SALMON | ||||||||
| VP CORPORATE COMMUNICATIONS | 40.00 | 0.00 | Yes (X) | Yes (X) | $110,909 | $0 | $0 | |
| MARIANNE LOVE | ||||||||
| DIRECTOR OF CORPORATE COMPLIANCE | 40.00 | 0.00 | Yes (X) | Yes (X) | $113,957 | $0 | $7,831 | |
| JOSEPH O'MALLEY | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 0.00 | Yes (X) | $261,433 | $0 | $16,600 | ||
| KEVIN PAYNE | ||||||||
| CHIEF OPERATIONS OFFICER A | 40.00 | 0.00 | Yes (X) | $282,869 | $0 | $8,097 | ||
| PERRY PETRILLI | ||||||||
| INTERIM CEO | 40.00 | 0.00 | Yes (X) | $122,242 | $0 | $0 | ||
| WILLIAM TIMMONS | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 0.00 | Yes (X) | $835,534 | $0 | $17,641 | ||
| DEBRA KULKAY | ||||||||
| DIRECTOR OF REVENUE CYCLE | 40.00 | 0.00 | $120,100 | $0 | $7,831 | Yes (X) | ||
| LAURA WORTHY | ||||||||
| CONTROLLER | 40.00 | 0.00 | $127,984 | $0 | $7,564 | Yes (X) | ||
| LINDA STILLMAN | ||||||||
| DIRECTOR OF HUMAN RESOURCES | 40.00 | 0.00 | $111,795 | $0 | $7,565 | Yes (X) | ||
| LORENA BOWERS | ||||||||
| DIRECTOR OF RESPIRATORY | 40.00 | 0.00 | $107,678 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,460,600 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $74,445 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $120,000 | GovernmentGrantsAmt |
| All Other Contributions | $79,071 | AllOtherContributionsAmt |
| Noncash Contributions | $6,707 | NoncashContributionsAmt |
| Total Contributions | $199,071 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| GOVERNMENT PATIENT SERVICE REVENU | 623990 | $20,503,131 | $20,503,131 |
| MEALS INCOME | 900099 | $144,207 | $144,207 |
| MANAGEMENT FEE | 561000 | $12,816 | $12,816 |
| PRIVATE PATIENT SERVICE REVENUE | 623990 | $5,382 | $5,382 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,665,536 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,690 | TotalRevenueColumnAmt |
| Exclusion | $8,690 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $608,501 | SecuritiesAmt |
| Other | $1,800 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $604,194 | SecuritiesAmt |
| Other | $975,985 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,307 | SecuritiesAmt |
| Other | -$974,185 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$969,878 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$974,185 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $4,307 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,903,419 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,691,351 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $12,997 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,789,532 | TotalAmt |
| Management And General | $1,789,532 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,775,701 | TotalAmt |
| Program Services | $12,433,544 | ProgramServicesAmt |
| Management And General | $342,157 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244,593 | TotalAmt |
| Program Services | $229,239 | ProgramServicesAmt |
| Management And General | $15,354 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,522,340 | TotalAmt |
| Program Services | $1,465,866 | ProgramServicesAmt |
| Management And General | $56,474 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,165,379 | TotalAmt |
| Program Services | $886,412 | ProgramServicesAmt |
| Management And General | $278,967 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $604,267 | TotalAmt |
| Management And General | $604,267 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,635 | TotalAmt |
| Management And General | $36,635 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,016 | TotalAmt |
| Management And General | $2,016 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,029,360 | TotalAmt |
| Program Services | $970,277 | ProgramServicesAmt |
| Management And General | $59,083 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,193 | TotalAmt |
| Program Services | $7,930 | ProgramServicesAmt |
| Management And General | $33,263 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,451 | TotalAmt |
| Program Services | $584 | ProgramServicesAmt |
| Management And General | $12,867 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,751 | TotalAmt |
| Management And General | $38,751 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $943,020 | TotalAmt |
| Program Services | $866,323 | ProgramServicesAmt |
| Management And General | $76,697 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,178 | TotalAmt |
| Management And General | $13,178 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $446,058 | TotalAmt |
| Program Services | $415,786 | ProgramServicesAmt |
| Management And General | $30,272 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $812,287 | TotalAmt |
| Program Services | $716,486 | ProgramServicesAmt |
| Management And General | $95,801 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $1,008,194 | $943,423 | $64,771 |
| BAD DEBT EXPENSE | $579,983 | $579,983 | |
| LOAN FORGIVENESS | $488,109 | $488,109 | |
| OTHER OPERATING EXPENSE | $341,769 | $36,079 | $305,690 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $784,433 | TotalAmt |
| Program Services | $670,385 | ProgramServicesAmt |
| Management And General | $114,048 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,680,249 | TotalAmt |
| Program Services | $20,222,317 | ProgramServicesAmt |
| Management And General | $4,457,932 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,242,161 | BOYAmt |
| EOY | $2,086,345 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $115,245 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,292,968 | BOYAmt |
| EOY | $1,572,368 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $181,469 | BOYAmt |
| EOY | $96,587 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $287,171 | BOYAmt |
| EOY | $453,639 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,721,993 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,015,623 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,825,854 | BOYAmt |
| EOY | $2,706,370 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $862,596 | BOYAmt |
| EOY | $317,454 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $206,910 | BOYAmt |
| EOY | $205,797 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,456 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,037,830 | BOYAmt |
| EOY | $7,438,560 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,103,930 | BOYAmt |
| EOY | $1,463,292 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,568 | BOYAmt |
| EOY | $68,567 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $831,562 | BOYAmt |
| EOY | $738,838 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,032,060 | BOYAmt |
| EOY | $2,270,697 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,964,209 | BOYAmt |
| EOY | $5,126,302 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,361 | BOYAmt |
| EOY | $38,361 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,200 | BOYAmt |
| EOY | $3,200 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,005,770 | BOYAmt |
| EOY | $5,167,863 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,037,830 | BOYAmt |
| EOY | $7,438,560 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$4,776,830 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$8,228 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$52,849 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $297,094 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $267,606 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $684,047 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $395,974 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $199,071 | CurrentTaxYearAmt |
| Total | $1,843,792 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $20,244,933 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $21,269,538 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $23,894,872 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,551,025 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $20,665,536 | CurrentTaxYearAmt |
| Total | $110,625,904 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $20,542,027 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $21,537,144 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $24,578,919 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,946,999 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $20,864,607 | CurrentTaxYearAmt |
| Total | $112,469,696 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $20,550 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,350 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,250 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,500 | CurrentTaxYearAmt |
| Total | $41,650 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $20,550 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,350 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,250 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,500 | CurrentTaxYearAmt |
| Total | $41,650 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $112,428,046 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,593 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,388 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,870 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,327 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,690 | CurrentTaxYearAmt |
| Total | $41,868 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,593 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,388 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,870 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,327 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,690 | CurrentTaxYearAmt |
| Total | $41,868 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $3,406 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $74,547 | CurrentTaxYearMinus2YearsAmt |
| Total | $77,953 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $20,552,620 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $21,546,938 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $24,660,336 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,956,326 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $20,873,297 | CurrentTaxYearAmt |
| Total | $112,589,517 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99860 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99900 | PublicSupportPY509Pct |
| Investment Income CY | 0.00040 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00040 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $41,561 | BeginningYearBalanceAmt |
| Other Expenditures | $3,282 | OtherExpendituresAmt |
| End Year Balance | $38,279 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $104,076 | BeginningYearBalanceAmt |
| Contributions | $54,089 | ContributionsAmt |
| Other Expenditures | $116,604 | OtherExpendituresAmt |
| End Year Balance | $41,561 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $15,942 | BeginningYearBalanceAmt |
| Contributions | $299,522 | ContributionsAmt |
| Other Expenditures | $211,388 | OtherExpendituresAmt |
| End Year Balance | $104,076 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $74,000 | OtherCostOrOtherBasisAmt |
| Book Value | $74,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,831,149 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,960,249 | DepreciationAmt |
| Book Value | $870,900 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,985,795 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,303,849 | DepreciationAmt |
| Book Value | $681,946 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,723,897 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,507,250 | DepreciationAmt |
| Book Value | $216,647 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,107,152 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,244,275 | DepreciationAmt |
| Book Value | $862,877 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,706,370 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION LIABILITY | $317,454 |
| DEFERRED SEVERANCE | $421,384 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $738,838 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $20,290,023 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$8,228 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $630 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$579,983 | OtherRevenueAmt |
| Revenue Not Reported | -$587,581 | RevenueNotReportedAmt |
| Revenue Subtotal | $20,877,604 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$974,185 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$974,185 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $19,903,419 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $25,075,081 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $630 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $974,185 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $974,815 | ExpensesNotReportedAmt |
| Expenses Subtotal | $24,100,266 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $579,983 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $579,983 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $24,680,249 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 AND THE STATE OF ARIZONA. AS OF JUNE 30, 2019, U.S. FEDERAL INFORMATIONAL AND INCOME TAX RETURNS FOR YEARS ENDED PRIOR TO JUNE 30, 2016 AND STATE RETURNS FOR YEARS ENDED PRIOR TO JUNE 30, 2015 ARE CLOSED TO ASSESSMENT. 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 -579,983. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF PROPERTY REPORTED AS REVENUE -974,185. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF PROPERTY REPORTED AS REVENUE 974,185. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE INCLUDED IN EXPENSES 579,983. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOSEPH O'MALLEY | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $238,326 | $0 | $23,107 | $0 | $0 | $0 | $0 | $0 | $16,600 | $0 | $278,033 | $0 | $0 | $0 |
| KEVIN PAYNE | ||||||||||||||
| CHIEF OPERATIONS OFFICER A | $232,749 | $0 | $50,120 | $0 | $0 | $0 | $0 | $0 | $8,097 | $0 | $290,966 | $0 | $0 | $0 |
| WILLIAM TIMMONS | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $735,534 | $0 | $100,000 | $0 | $0 | $0 | $0 | $0 | $17,641 | $0 | $853,175 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd | TransactionTransactionAmt |
|---|---|---|---|
| POMEROY GROUP | |||
| 100% OWNED BY BOARD PRESIDENT | DURING THE YEAR ENDED JUNE 30, 2019, AN ENTITY OWNED BY THE BOARD PRESIDENT OF THE ORGANIZATION, WHO RESIGNED IN FEBRUARY 2019, WAS ENGAGED BY HHC TO PROVIDE INSURANCE BROKERAGE SERVICES TO THE ORGANIZATION AND ITS RELATED AFFILIATES. COMMISSIONS WERE PAID TO THIS ENTITY IN THE AMOUNTS OF APPROXIMATELY $315,000 FOR THE YEAR ENDED JUNE 30, 2019. THESE COMMISSION AMOUNTS WERE NOT PAID BY THE ORGANIZATION OR AFFILIATES OF THE ORGANIZATION; THEY WERE PAID DIRECTLY BY THE INSURANCE COMPANY. | 0 | |
| SIERRA WALLWORK | |||
| DAUGTHER OF BOARD MEMBER | COMPENSATION AS VP OF MARKETING & PUBLIC RELATIONS | 0 | $117,894 |
| THOMAS NIEMIEC | |||
| SON OF BOARD MEMBER | COMPENSATION AS TECHNOLOGY PROGRAM MANAGER | 0 | $40,580 |
| MICHELLE NIEMIC | |||
| DAUGTHER OF BOARD MEMBER | COMPENSATION AS RT | 0 | $56,323 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART VI | FormAndLineReferenceDesc |
| Explanation | , 100% OWNED BY TOM POMEROY, BOARD PRESIDENT, WAS HIRED BY HACIENDA CHILDRENS HOSPITAL (HCH) AND RELATED AFFILIATES FOR HIS SERVICES AS THE ENTITY'S (AND RELATED AFFILIATES') INSURANCE BROKER. HOWEVER, HCH AND RELATED AFFILIATES DID NOT MAKE ANY PAYMENTS TO TOM POMEROY FOR THESE SERVICES AS HIS WHOLLY OWNED BROKERAGE COMPANY WAS PAID DIRECTLY BY THE INSURANCE COMPANIES IN THE FORM OF COMMISSIONS. PER THE IRS INSTRUCTIONS TO PART IV OF SCHEDULE L, "IN GENERAL, AN ORGANIZATION MUST REPORT BUSINESS TRANSACTIONS IN PART IV WITH AN INTERESTED PERSON IF: (1) ALL PAYMENTS DURING THE TAX YEAR BETWEEN THE ORGANIZATION AND THE INTERESTED PERSON EXCEEDED $100,000..." SINCE THERE WERE NO PAYMENTS BETWEEN HCH AND TOM POMEROY, THE AMOUNT IN PART IV IS REPORTED AS ZERO. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S CEO 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 | 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SOUTH MOUNTAIN HEALTH SUPPLY | |||||||||
| 1402 E SOUTH MOUNTAIN AVE | PHOENIX | AZ | 85042 | 860858893 | MEDICAL SUPPLY COMPANY | AZ | N/A | C | 0 |
| INNOVATIVE HOME HEALTH INC | |||||||||
| 1402 E SOUTH MOUNTAIN AVE | PHOENIX | AZ | 85042 | 262398755 | HOME HEALTH NURSING SERVICES | AZ | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | Yes (1) | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH MOUNTAIN HEALTH SUPPLY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | H | TransactionTypeTxt |
| Involved | $768,365 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |
Comments