2017-06-15T14:39:08-05:00 2016-07-31 860133881 HENRY & HORNE LLP 2055 E WARNER RD STE 101 TEMPE AZ 85284 990 2015-08-01 473035370 HACIENDA CHILDRENS HOSPITAL INC HACI 6022434231 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 WILLIAM TIMMONS CEO 6022434231 2017-06-15 1 COLETTE KAMPS CPA P00367616 4808394900 2017-06-14 2015 2021-01-29 14:40:06Z X WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 595005 0 X WWW.HACIENDAHEALTHCARE.ORG X 2015 AZ PROVIDE HIGH QUALITY ACUTE AND SUB-ACUTE CARE FOR INFANTS, CHILDREN AND TEENS. 9 9 22 9 0 0 154664 439027 0 1314 595005 0 0 1500132 0 0 1363518 2863650 -2268645 11322554 175061 11147493 PROVIDE HIGH QUALITY ACUTE AND SUB-ACUTE CARE FOR INFANTS, CHILDREN AND TEENS. 0 0 2703650 440341 HACIENDA CHILDREN'S HOSPITAL (HCH) SERVES THE NEEDS OF ACUTE AND CHRONICALLY ILL PATIENTS. THE 24-BED HOSPITAL PROVIDES NON-EMERGENCY, NON-SURGICAL, STEP-DOWN MEDICAL CARE TO CHILDREN AND HANDS-ON TRAINING TO EACH PARENT, ALL IN A TRANQUIL, FAMILY-CENTERED ATMOSPHERE. 2703650 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 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 0 22 1 0 0 0 0 0 0 0 1 1 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 AVE PHOENIX AZ 85042 PATRICK WALSH PRESIDENT OF THE BOARD 0.50 2.50 X X 0 0 0 TOM POMEROY EXECUTIVE VICE PRESIDENT OF THE BOARD 0.50 2.50 X X 0 0 0 KATHRYN L DEL REAL VICE PRESIDENT OF THE BOARD 0.50 2.50 X X 0 0 0 RALPH WALLWORK TREASURER OF THE BOARD 0.50 2.50 X X 0 0 0 MIKE WADE SECRETARY OF THE BOARD 0.50 2.50 X X 0 0 0 GARY ORMAN BOARD MEMBER 0.25 1.50 X 0 0 0 KEVIN BERGER BOARD MEMBER 0.25 1.50 X 0 0 0 THOM NIEMIEC BOARD MEMBER 0.25 1.50 X 0 0 0 PATRICK WHITE BOARD MEMBER 0.25 1.50 X 0 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 5.00 40.00 X 0 578397 30519 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 5.00 40.00 X 0 200114 16629 DANI AALFS CHIEF OPERATIONS OFFICER ADMIN SERVICES 5.00 40.00 X 0 113419 13574 KEVIN PAYNE CHIEF OPERATING OFFICER OPERATIONS 5.00 40.00 X 0 132703 13010 PERRY PETRILLI VP- RESIDENTIAL SERVICES 5.00 40.00 X 0 108794 4082 MARIANNE COPPOLA DIRECTOR OF CORPORATE COMPLIANCE 5.00 40.00 X 0 102496 4186 0 1235923 82000 1 0 1 0 HACIENDA INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 MANAGEMENT SERVICES 160000 1 154664 14833 154664 PRIVATE SECTR REVENUE 623990 431842 431842 GOVERNMENT FEES FOR SE 623990 7185 7185 439027 MISCELLANEOUS REVENUE 900099 1314 1314 1314 595005 440341 0 0 1310380 1310380 28763 28763 160989 160989 160000 160000 100205 100205 25471 25471 4499 4499 289616 289616 438906 438906 56700 56700 SUPPLIES 246455 246455 FOOD 18441 18441 OTHER OPERATING EXPENSE 15477 15477 DUES, LICESNES, AND PER 7748 7748 2863650 2703650 160000 0 400 28069 204093 32074 9621 11487203 438906 0 11048297 0 11322554 175061 0 175061 X 11114924 32569 0 11147493 0 11322554 X -2268645 13416138 X 0 1 X 1 0 X 154664 154664 439027 439027 593691 593691 0 0 0 593691 1314 1314 595005 595005 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 795024 795024 9566723 305863 9260860 17773 955 16818 881054 118238 762816 226629 13850 212779 11048297 X 595005 0 595005 0 595005 2863650 0 2863650 0 2863650 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 JULY 31, 2016, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCAL STATEMENTS. 1 1 1 X 1 X 1 0 1 1 2388514 2388514 0.83410 2388514 2388514 0.83410 2388514 2388514 0.83410 1 170739 0 0 X 1 1 1 1 HACIENDA CHILDREN'S HOSPITAL INC 610 W JEROME AVE MESA AZ 85210 X X HACIENDA CHILDREN'S HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X HTTP://HACIENDAINC.ORG/WP-CONTENT/UPLOADS/HCH_CHNA_2016-2018_REV.PDF X 1 15 1 HTTP://HACIENDAINC.ORG/WP-CONTENT/UPLOADS/HCH_CHNA_2016-2018_REV.PDF 0 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X 1 X 1 X X X 0 X X 0 X X 0 0 HACIENDA CHILDREN'S HOSPITAL, INC. PART V, SECTION B, LINE 5: THE ARIZONA STATE HEALTH ASSESSMENT AND THE MARICOPA COUNTY COORDINATED COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED INPUT FROM COMMUNITY MEMBERS AND ORGANIZATIONS AS WELL AS SURVEYS DONE BY UNDERSERVED AND MINORITY MEMBERS OF THE COMMUNITY. HACIENDA CHILDREN'S HOSPITAL SOLICITS INPUT FROMPERSONS REPRESENTING THE COMMUNITY'S INTEREST VIA EMAIL AND THROUGH OUR MARKETING AND PHILANTHROPY DEPARTMENT MEETINGS WITH VARIOUS ORGANIZATIONS AND AGENCIES. HACIENDA CHILDREN'S HOSPITAL ALSO CONTINUES TO RECEIVE FEEDBACK FROM FAMILY MEMBERS VIA SURVEYS CONDUCTED PRIOR TO DISCHARGE REGARDING PERCEIVED COMMUNITY HEALTH NEEDS, AND INCORPORATE THEM INTO OUR ASSESSMENTS. HACIENDA CHILDREN'S HOSPITAL, INC. PART V, SECTION B, LINE 11: THE MAJORITY OF OUR FAMILIES ARE ON MEDICAID AND RECEIVE FINANCIAL ASSISTANCE. THEY FEEL THAT EATING HEALTHY IS NOT AN OPTION BECAUSE OF THE COSTS INVOLVED. WE PROVIDE RESOURCES AND LITERATURE FOR THE FAMILIES TO HELP THEM FIND LOWER COST FOODS THAT ARE ALSO NUTRITIONALLY DENSE. PART II, COMMUNITY BUILDING ACTIVITIES: WE COMPLETE NUTRITION SURVEYS WITH EACH FAMILY IN ORDER TO IDENTIFY BARRIERS THEY HAVE TO HEALTHY EATING. PART III, LINE 4: THE CARRYING AMOUNT OF ACCOUNTS RECEIVABLE MAY BE REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF UNCOLLECTIBLE AMOUNTS. MANAGEMENT REVIEWS ALL ACCOUNTS RECEIVABLE BALANCES PERIODICALLY, AND BASED ON AN ASSESSMENT OF CREDITWORTHINESS AND AN ANALYSIS OF THE AGING OF INVOICES, ESTIMATES THE PORTION, IF ANY, OF THE BALANCES THAT WILL NOT BE COLLECTED. BECAUSE OF THE INHERENT UNCERTAINTIES IN ESTIMATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS, IT IS AT LEAST REASONABLY POSSIBLE THAT THE ESTIMATES USED WILL CHANGE WITHIN THE NEAR TERM. PART III, LINE 8: THE COSTING METHODOLOGY WAS BASED ON A COST TO CHARGE RATIO FORMULA, INFORMATION WAS OBTAINED FORM THE DSH REPORT. PART III, LINE 9B: ALL GUARANTORS WITH SELF-PAY BALANCES ARE PROVIDED WITH A CHARITY CARE FINANCIAL ASSISTANCE APPLICATION TO DETERMINE IF THEY QUALIFY FOR ASSISTANCE. HOSPITAL BILLING STAFF REVIEWS EACH RETURNED APPLICATION, FOLLOWS UP WITH THE GUARANTOR FOR ANY QUESTIONS AND MISSING INFORMATION, AND COMMUNICATES ELIGIBILITY STATUS TO THE GUARANTOR. PART VI, LINE 2: A FOCUSED APPROACH TO UNDERSTANDING THE NEEDS WITHIN THE UNDERSERVED AND MINORITY POPULATION IN WHICH HCH SERVES INCLUDED AN ANALYSIS OF THE INPUT PROVIDED BY THE MARICOPA COUNTY COORDINATED COMMUNITY HEALTH NEEDS ASSESSMENT AS WELL AS THE ARIZONA STATE HEALTH ASSESSMENT. PART VI, LINE 4: THE COMMUNITY HACIENDA CHILDREN'S HOSPITAL SERVES, CONSISTS MAINLY OF MEDICALLY UNDERSERVED,LOW INCOME AND MINORITY POPULATIONS. HACIENDA CHILDREN'S HOSPITAL SERVES PEDIATRIC PATIENTS ONLY. THE AVERAGE AGE OF OUR ADMISSIONS IS 20.3 MONTHS OLD. THE OVERWHELMING MAJORITY OF OUR PATIENTS ARE MEDICAID RECIPIENTS. WE SERVICE THE HIGHEST NUMBER OF MEDICAID PATIENTS OF ANY HOSPITAL PROVIDER INTHE STATE, 96% IN OUR FIRST YEAR. MOST FAMILIES OF OUR PATIENTS HAVE MULTIPLE CHILDREN AND FACE ADDITIONAL BARRIERS TO HEALTH ACCESS AND HAVE MULTIPLE SOCIAL SUPPORT NEEDS. WITHIN OUR FIRST YEAR, 57% OF THE PATIENTS ADMITTED TO HACIENDA CHILDREN'S HOSPITAL WERE OF HISPANIC OR NATIVE AMERICAN ETHNICITY,AND 41% WERE CAUCASIAN. HACIENDA CHILDREN'S HOSPITAL'S GEOGRAPHIC COMMUNITY CONSISTS OF MARICOPA COUNTY. THE MAJORITY OF HACIENDA CHILDREN'S HOSPITAL'S ADMISSIONS COME FROM CARDON CHILDREN'S MEDICAL CENTER, PHOENIX CHILDREN'S HOSPITAL AND THE MARICOPA INTEGRATED HEALTH SYSTEM. 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. SOUTH MOUNTAIN HEALTH SUPPLY INC (SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION. 105000 THE FILING ORGANIZATION PURCHASES HEALTH CARE SUPPLIES FROM SMHS. 0 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S BOARD TREASURER, CEO AND CONTROLLER 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 XI, LINE 9: TRANSFER OF LAND, PROPERTY AND EQUIPMENT FROM AFFILIATE 10,930,906. OTHER TRANSFERS FROM AFFILIATES 2,485,232. HACIENDA INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860253158 CARE FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 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 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 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 1 0