2020-08-31T15:03:59-05:00 2019-06-30 860271207 SCHMIDT WESTERGARD & COMPANY PLLC 77 WEST UNIVERSITY DRIVE MESA AZ 852015830 990 2018-07-01 860253158 HACIENDA INC HACI 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 PERRY PETRILLI INTERIM CEO 6022434231 2020-08-31 1 JEFFREY A BITHER P01428424 4808346030 216.27.213.138 2020-08-31 12:14:36 MS P 7394AA94C9A7FD3CE8BD2126D65D769B8B7F5BB4 7407511015FCE34E7FE0015C7B8225BB6A28E7B5 2018 2020-11-19 02:30:22Z X PERRY PETRILLI 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 21483598 0 X HTTPS://WWW.HACIENDAINC.ORG/ X 1970 AZ PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 3 3 660 3 0 0 395974 199071 24551025 20665536 6509 -961188 0 0 24953508 19903419 35000 0 0 0 19801527 17497545 0 0 0 4871367 7182704 24707894 24680249 245614 -4776830 13037830 7438560 3032060 2270697 10005770 5167863 X PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 0 0 12803658 12169597 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. 5264003 6141411 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. 1923386 1119846 THE ORGANIZATION OPERATES A DAY TREATMENT JOB AND TRAINING PROGRAM IN PHOENIX, ARIZONA FOR ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. 231270 260497 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. 231270 260497 20222317 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 40 0 1 660 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 AZ X THE ORGANIZATION 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 GARY ORMAN EXECUTIVE VICE PRESIDENT 1.00 3.00 X X 0 0 0 JANET LOVELADY DIRECTOR OF NURSING 40.00 0.00 X X 126003 0 0 JIM GERDES BOARD MEMBER 0.50 1.50 X 0 0 0 KATHRYN DEL REAL VICE PRESIDENT 40.00 0.00 X X 0 0 0 KEVIN BERGER BOARD MEMBER 0.50 1.50 X 0 0 0 MIKE WADE SECRETARY 1.00 3.00 X X 0 0 0 PATRICK WHITE ACTING CEO 40.00 1.50 X 140096 0 1316 RALPH WALLWORK TREASURER 1.00 3.00 X X 0 0 0 THOM NIEMIEC BOARD MEMBER 0.50 1.50 X 0 0 0 TOM POMEROY PRESIDENT 1.00 3.00 X X 0 0 0 NANCY SALMON VP CORPORATE COMMUNICATIONS 40.00 0.00 X X 110909 0 0 MARIANNE LOVE DIRECTOR OF CORPORATE COMPLIANCE 40.00 0.00 X X 113957 0 7831 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 40.00 0.00 X 261433 0 16600 KEVIN PAYNE CHIEF OPERATIONS OFFICER A 40.00 0.00 X 282869 0 8097 PERRY PETRILLI INTERIM CEO 40.00 0.00 X 122242 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 40.00 0.00 X 835534 0 17641 DEBRA KULKAY DIRECTOR OF REVENUE CYCLE 40.00 0.00 X 120100 0 7831 LAURA WORTHY CONTROLLER 40.00 0.00 X 127984 0 7564 LINDA STILLMAN DIRECTOR OF HUMAN RESOURCES 40.00 0.00 X 111795 0 7565 LORENA BOWERS DIRECTOR OF RESPIRATORY 40.00 0.00 X 107678 0 0 2460600 0 74445 12 0 1 0 0 120000 79071 6707 199071 GOVERNMENT PATIENT SERVICE REVENU 623990 20503131 20503131 MEALS INCOME 900099 144207 144207 MANAGEMENT FEE 561000 12816 12816 PRIVATE PATIENT SERVICE REVENUE 623990 5382 5382 20665536 8690 8690 608501 1800 604194 975985 4307 -974185 -969878 -974185 4307 19903419 19691351 0 12997 1789532 1789532 12775701 12433544 342157 244593 229239 15354 1522340 1465866 56474 1165379 886412 278967 604267 604267 36635 36635 2016 2016 1029360 970277 59083 41193 7930 33263 13451 584 12867 38751 38751 943020 866323 76697 13178 13178 446058 415786 30272 812287 716486 95801 SUPPLIES 1008194 943423 64771 BAD DEBT EXPENSE 579983 579983 LOAN FORGIVENESS 488109 488109 OTHER OPERATING EXPENSE 341769 36079 305690 784433 670385 114048 24680249 20222317 4457932 0 6242161 2086345 115245 0 2292968 1572368 181469 96587 287171 453639 8721993 6015623 2825854 2706370 862596 317454 206910 205797 23456 0 13037830 7438560 2103930 1463292 96568 68567 831562 738838 3032060 2270697 X 9964209 5126302 38361 38361 3200 3200 10005770 5167863 13037830 7438560 -4776830 -8228 -52849 0 X 0 1 X 0 0 X 297094 267606 684047 395974 199071 1843792 20244933 21269538 23894872 24551025 20665536 110625904 20542027 21537144 24578919 24946999 20864607 112469696 20550 17350 1250 2500 41650 0 20550 17350 1250 2500 41650 112428046 10593 6388 6870 9327 8690 41868 10593 6388 6870 9327 8690 41868 3406 74547 77953 20552620 21546938 24660336 24956326 20873297 112589517 0.99860 0.99900 0.00040 0.00040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 41561 3282 38279 104076 54089 116604 41561 15942 299522 211388 104076 0.00000 0.00000 1.00000 0 0 74000 74000 2831149 1960249 870900 1985795 1303849 681946 1723897 1507250 216647 2107152 1244275 862877 2706370 DEFERRED COMPENSATION LIABILITY 317454 DEFERRED SEVERANCE 421384 738838 X 20290023 -8228 630 -579983 -587581 20877604 -974185 -974185 19903419 25075081 630 974185 974815 24100266 579983 579983 24680249 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. X X X 0 0 0 0 0 0 0 0 0 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 238326 0 23107 0 0 0 0 0 16600 0 278033 0 0 0 KEVIN PAYNE CHIEF OPERATIONS OFFICER A 232749 0 50120 0 0 0 0 0 8097 0 290966 0 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 735534 0 100000 0 0 0 0 0 17641 0 853175 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. 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 117894 COMPENSATION AS VP OF MARKETING & PUBLIC RELATIONS 0 THOMAS NIEMIEC SON OF BOARD MEMBER 40580 COMPENSATION AS TECHNOLOGY PROGRAM MANAGER 0 MICHELLE NIEMIC DAUGTHER OF BOARD MEMBER 56323 COMPENSATION AS RT 0 PART VI , 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. 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. 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 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 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 1 0 1 SOUTH MOUNTAIN HEALTH SUPPLY H 768365 FMV