2017-04-24T18:26:22-05:00 2016-06-30 860133881 HENRY & HORNE LLP 2055 E WARNER RD STE 101 TEMPE AZ 85284 990 2015-07-01 141906233 HACIENDA SKILLED NURSING FACILITY INC HACI 6022434231 1402 EAST SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 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 EAST SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 10698099 0 X WWW.HACIENDAHEALTHCARE.ORG X 2004 AZ SKILLED NURSING AND RESPIRATORY INTERVENTION 9 9 171 9 0 0 34972 32751 10081164 10663731 1481 1617 0 0 10117617 10698099 0 0 0 0 6188079 6513390 0 0 0 2978290 3774377 9166369 10287767 951248 410332 10633683 10602037 4098096 3464987 6535587 7137050 TO PROVIDE NURSING AND RESPIRATORY CARE TO THOSE WHO REQUIRE FREQUENT SKILLED NURSING AND RESPIRATORY INTERVENTION. 0 0 10108417 10663731 ARIZONA'S FIRST SKILLED NURSING FACILITY FOR INFANTS, CHILDREN, TEENS, AND YOUNG ADULTS. CARE FOR MEDICALLY FRAGILE PATIENTS WHO REQUIRE FREQUENT SKILLED NURSING AND RESPIRATORY INTERVENTIONS. 10108417 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 171 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 1 1 1 1 1 1 1 1 0 AZ X THE ORGANIZATION 6022434231 1402 EAST SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 X PATRICK WALSH PRESIDENT 0.50 2.50 X X 0 0 0 TOM POMEROY EXECUTIVE VICE PRESIDENT 0.50 2.50 X X 0 0 0 KATHRYN L DEL REAL VICE PRESIDENT 0.50 2.50 X X 0 0 0 RALPH WALLWORK TREASURER 0.50 2.50 X X 0 0 0 MIKE WADE SECRETARY 0.50 2.50 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 10.00 30.00 X 0 578397 30519 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 10.00 30.00 X 0 200114 16629 DANI AALFS CHIEF OPERATIONS OFFICER ADMIN SERVICES 10.00 30.00 X 0 113419 13574 KEVIN PAYNE CHIEF OPERATING OFFICER OPERATIONS 10.00 30.00 X 0 132703 13010 JANET LOVELADY DIRECTOR OF NURSING 10.00 30.00 X 141857 0 5674 ROXANNE ROSE ADON FOR THE SNF 40.00 0.00 X 129171 0 6295 JULIE ELLSWORTH SNF RN 40.00 0.00 X 105653 0 4178 MARIANNE COPPOLA DIRECTOR OF CORPORATE COMPLIANCE 10.00 30.00 X 102496 0 4186 PERRY PETRILLI VP- RESIDENTIAL SERVICES 10.00 30.00 X 108803 0 4082 587980 1024633 98147 3 0 1 0 LOS NINOS HOSPITAL INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 NURSING REGISTRY AND THERAPY SERVICES 609253 HACIENDA INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 MANAGMENT SERVICES 159300 2 32751 14419 32751 PRIVATE PATIENT SERVICE REVENUES 623000 9181359 9181359 GOVERNMENT PATIENT SERVICE REVENU 623000 749583 749583 NURSING FACILITY SUPPLEMENTS 623000 389769 389769 PROGRAM RENTAL INCOME 532000 313098 313098 OVERPAYMENTS - INSURANCE 623000 29922 29922 10663731 1617 1617 10698099 10663731 0 1617 5563211 5563211 119095 119095 327364 327364 503720 503720 159300 159300 20050 20050 786556 786556 18273 18273 2644 2644 303150 303150 36325 36325 339644 339644 285247 285247 SUPPLIES 973710 973710 MEDICAL EQUIPMENT 296452 296452 BED TAX EXPENSE 203167 203167 FOOD 179906 179906 169953 169953 10287767 10108417 179350 0 6596 2382 1548910 1810681 2558 3086 2055 4281 11611920 2987122 8908262 8624798 165302 156809 10633683 10602037 444865 478908 3653231 2986079 4098096 3464987 X 6285267 6915725 250320 221325 6535587 7137050 10633683 10602037 X 410332 -8689 199820 X X 0 1 X 1 0 X 420618 49704 1607842 34972 32751 2145887 8037896 8879929 9198450 10081164 10758004 46955443 8458514 8929633 10806292 10116136 10790755 49101330 265600 265600 0 265600 265600 48835730 671 13250 1252 1481 1617 18271 671 13250 1252 1481 1617 18271 8459185 8942883 10807544 10117617 10792372 49119601 0.99420 0.99380 0.00040 0.00040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9204689 2025818 7178871 207241 85741 121500 576452 450165 126287 1623538 425398 1198140 8624798 X 10689410 -8689 -8689 10698099 0 10698099 10287767 0 10287767 0 10287767 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 0 503397 0 75000 0 0 0 18777 0 11742 0 608916 0 0 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 0 184434 0 15680 0 0 0 7748 0 8881 0 216743 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. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S BOARD TREASURER, CEO AND CFO 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 MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII HACIENDA SKILLED NURSING FACILITY, INC. IS RELATED TO TWO TAX EXEMPT AFFILIATES, HACIENDA, INC. AND LOS NINOS HOSPITAL, INC. THESE THREE ORGANIZATIONS SHARE A COMMON MANAGEMENT TEAM. THE INDIVIDUALS ON THE MANAGEMENT TEAM ARE COMPENSATED AS EMPLOYEES THROUGH HACIENDA, INC. HACIENDA, INC. CHARGES A MANAGEMENT FEE FOR THESE SERVICES TO BOTH LOS NINOS HOSPITAL, INC. AND TO HACIENDA SKILLED NURSING FACILITY, INC. THE COMPENSATION AMOUNTS LISTED IN PART VII ARE THE TOTAL GROSS WAGES AND OTHER COMPENSATION PAID TO THESE INDIVIDUALS FOR THEIR SERVICES TO ALL THREE ORGANIZATIONS. FORM 990, PART XI, LINE 9: TRANSFER FROM AFFILIATES 199,820. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED THE PROCESS FROM PRIOR YEARS. HACIENDA INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860253158 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 AFFILIATED ORGANIZATIONS AZ N/A C 0 0 0 1 1 1 0 0 0 0 1 0 0 1 1 1 1 0 0 0