2017-04-24T18:26:48-05:00 2016-06-30 860133881 HENRY & HORNE LLP 2055 E WARNER RD STE 101 TEMPE AZ 85284 990 2015-07-01 860253158 HACIENDA INC HACI 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 WILLIAM TIMMONS CEO 6022434231 2017-04-24 1 COLETTE KAMPS CPA P00367616 4808394900 2017-04-22 2015 2021-01-29 14:40:06Z WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 21546938 0 X WWW.HACIENDAHEALTHCARE.ORG X 1970 AZ PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 9 9 604 9 0 0 297094 267606 20197313 21269538 10593 6388 47620 3406 20552620 21546938 0 0 0 0 15672873 17151920 0 0 0 5102591 5172711 20775464 22324631 -222844 -777693 6893997 6899131 2708829 2907522 4185168 3991609 X PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 0 0 12069661 14036362 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 PATIENTS 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 PROVIDES 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. 5376624 6351165 GROUP HOMES, MEDICAL GROUP HOMES AND AUTISM GROUP HOME: THE ORGANIZATION OPERATES EIGHT GROUP HOMES IN THE COMMUNITY; FIVE THAT ARE MEDICAL FACILITIES AND TWO TRADITIONAL GROUP HOMES AND ONE AUTISM GROUP 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 (CONTINUED ON SCHEDULE O) 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 THESE 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. 734336 885417 THE ORGANIZATION OPERATES A DAY TREATMENT AND TRAINING PROGRAM IN PHOENIX, ARIZONA FOR ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. 18180621 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 26 0 604 1 0 0 0 0 0 0 0 0 0 0 X 9 9 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 85040 PATRICK WALSH PRESIDENT 1.00 2.00 X X 0 0 0 TOM POMEROY EXECUTIVE VICE PRESIDENT 1.00 2.00 X X 0 0 0 KATHRYN L DEL REAL VICE PRESIDENT 1.00 2.00 X X 0 0 0 RALPH WALLWORK TREASURER 1.00 2.00 X X 0 0 0 MIKE WADE SECRETARY 1.00 2.00 X X 0 0 0 GARY ORMAN BOARD MEMBER 0.50 1.00 X 0 0 0 KEVIN BERGER BOARD MEMBER 0.50 1.00 X 0 0 0 THOM NIEMIEC BOARD MEMBER 0.50 1.00 X 0 0 0 PATRICK WHITE BOARD MEMBER 0.50 1.00 X 0 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 20.00 20.00 X 578397 0 30519 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 20.00 20.00 X 200114 0 16629 DANI AALFS CHIEF OPERATIONS OFFICER ADMIN SERVICES 20.00 20.00 X 113419 0 13574 KEVIN PAYNE CHIEF OPERATING OFFICER OPERATIONS 20.00 20.00 X 132703 0 13010 JANET LOVELADY DIRECTOR OF NURSING 20.00 20.00 X 141857 0 5674 LISA LECOMTE ICF-ID ADMINISTRATOR 40.00 0.00 X 115661 0 2313 HEATHER TEAFORD ICF RN 40.00 0.00 X 126063 0 13495 PERRY PETRILLI VP- RESIDENTIAL SERVICES 20.00 20.00 X 0 108803 4082 MARIANNE COPPOLA DIRECTOR OF CORPORATE COMPLIANCE 20.00 20.00 X 102496 0 4186 1510710 108803 103482 9 0 1 0 0 19436 248170 122545 267606 GOVERNMENT PATIENT SERVICE REVENU 623990 19825358 19825358 MANAGEMENT FEE 561000 1109106 1109106 PRIVATE PATIENT SERVICE REVENUE 623990 271597 271597 MEALS INCOME 623990 63477 63477 21269538 6388 6388 MISCELLANEOUS INCOME 623990 3406 3406 3406 21546938 21272944 0 6388 1077180 1077180 13178853 10649660 2529193 2895887 2796040 99847 196907 196907 27050 27050 95885 95885 190767 148248 42519 142294 116986 25308 29881 23309 6572 788459 779307 9152 15888 15255 633 420289 410771 9518 484979 468673 16306 SUPPLIES 1621515 1600963 20552 OTHER OPERATING EXPENSE 326516 283102 43414 EQUIPMENT EXPENSE 322879 297654 25225 FLEET EXPENSE 193648 193648 315754 301120 14634 22324631 18180621 4144010 0 4954 4860 120775 1839296 2018783 152245 195587 467597 490565 8083892 4865463 3567044 3218429 666816 660564 180105 176943 15940 12625 6893997 6899131 1873888 2102602 173688 149219 661253 655701 2708829 2907522 X 4123042 3975667 58926 12742 3200 3200 4185168 3991609 6893997 6899131 X -777693 -7047 591181 X X 0 1 X 1 0 X 70656 230153 775806 297094 267606 1641315 16151219 15013476 19991096 20244933 21269538 92670262 16221875 15243629 20766902 20542027 21537144 94311577 0 0 0 94311577 5810 6912 10593 6388 29703 5810 6912 10593 6388 29703 16221875 15249439 20773814 20552620 21543532 94341280 0.99970 0.99970 0.00030 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 95885 95885 0 PART II-B, LINE 1: THIRD PARTY LOBBYIST 74000 74000 5142000 2864372 2277628 2858560 2001091 857469 9332 9332 3218429 DEFERRED COMPENSATION LIABILITY 655701 655701 X 21540691 -7047 800 -6247 21546938 0 21546938 22325431 800 800 22324631 0 22324631 PART X, LINE 2: THE ORGANIZATION RECOGNIZES UNCERTAIN TAX POSITIONS IN THE FINANCIAL STATEMENTS WHEN IT IS MORE LIKELY THAN NOT THE POSITIONS WILL NOT BE SUSTAINED UPON EXAMINATION BY THE TAX AUTHORITIES. AS OF JUNE 30, 2016, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. X X X 0 0 0 0 0 0 0 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 503397 0 75000 0 0 0 18777 0 11742 0 608916 0 0 0 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 184434 0 15680 0 0 0 7748 0 8881 0 216743 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. HACIENDA HEALTHCARE IS A COMPLEX, MULTI-FACETED HEALTH CARE AND SOCIAL SERVICE DELIVERY SYSTEM THAT PROVIDES 43 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. THE HACIENDA HEALTHCARE BOARD OF DIRECTORS APPROVES CHANGES IN EXECUTIVE COMPENSATION BEFORE THE CHANGES TAKE PLACE. THE ANNUAL EXECUTIVE COMPENSATION COMPARABILITY DATA STUDY AND THE BOARD OF DIRECTORS' APPROVAL OF EXECUTIVE COMPENSATION ARE DOCUMENTED. SOUTH MOUNTAIN HEALTH SUPPLY INC (SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION 1912351 THE FILING ORGANIZATION PURCHASES HEALTH CARE SUPPLIES FROM SMHS. 0 X VEHICLES 2 103700 FAIR MARKET VALUE X TICKETS AND OTHER 5 14442 FAIR MARKET VALUE X TOYS AND CLOTHING 7 3403 FAIR MARKET VALUE X HOSPITAL BED 1 1000 FAIR MARKET VALUE 0 0 0 PART I, COLUMN (B): THE NUMBER REPORTED IN COLUMN B OF PART 1 OF SCHEDULE M REPRESENTS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S CEO, TREASURER AND CFO 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. FORM 990, PART XI, LINE 9: TRANSFERS FROM AFFILIATES 591,181. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED THE PROCESS FROM THE PRIOR YEAR. HACIENDA SKILLED NURSING FACILITY INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 141906233 NURSING CARE & RESPIRATORY INTERVENTION AZ 501(C)(3) LINE 9 N/A 0 LOS NINOS HOSPITAL INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860892673 NON-PROFIT CHILDREN'S HOSPITAL AZ 501(C)(3) LINE 9 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 9 N/A 0 SOUTH MOUNTAIN HEALTH SUPPLY 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860858893 MEDICAL SUPPLY COMPANY AZ HACIENDA HEALTHCARE C 0 INNOVATIVE HOME HEALTH INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 262398755 HOME HEALTH NURSING SERVICES AZ HACIENDA HEALTHCARE C 0 HACIENDA HEALTHCARE 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 272988610 BRAND NAME FOR RELATED AFFILIATES AZ N/A C 0 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 0 1 0 1