HACIENDA SKILLED NURSING FACILITY INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
HACIENDA SKILLED NURSING FACILITY INC (EIN 14-1906233)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-05-16
IRS object ID
201631379349309293
Schema version
2014v6.0
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

FieldValueIRS element (for citing)
Return2016-05-16T16:28:42-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN860133881PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HENRY & HORNE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12055 E WARNER RD STE 101AddressLine1Txt
CityTEMPECityNm
State AbbreviationAZStateAbbreviationCd
ZIP85284ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN141906233EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HACIENDA SKILLED NURSING FACILITY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHACIBusinessNameControlTxt
Phone6022434231PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 EAST SOUTH MOUNTAIN AVENUEAddressLine1Txt
CityPHOENIXCityNm
State AbbreviationAZStateAbbreviationCd
ZIP85042ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonWILLIAM TIMMONSPersonNm
Person TitleCEOPersonTitleTxt
Phone6022434231PhoneNum
Signature2016-05-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCOLETTE KAMPS CPAPreparerPersonNm
PTINP00367616PTIN
Phone4808394900PhoneNum
Preparation2016-05-13PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerWILLIAM TIMMONSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 EAST SOUTH MOUNTAIN AVENUEAddressLine1Txt
CityPHOENIXCityNm
State AbbreviationAZStateAbbreviationCd
ZIP85042ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$10,117,617GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.HACIENDAHEALTHCARE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2004FormationYr
Legal Domicile StateAZLegalDomicileStateCd
Activity Or MissionSKILLED NURSING AND RESPIRATORY INTERVENTIONActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee179TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,607,842PYContributionsGrantsAmt
CY Contributions Grants$34,972CYContributionsGrantsAmt
PY Program Service Revenue$9,515,116PYProgramServiceRevenueAmt
CY Program Service Revenue$10,081,164CYProgramServiceRevenueAmt
PY Investment Income$1,252PYInvestmentIncomeAmt
CY Investment Income$1,481CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$11,124,210PYTotalRevenueAmt
CY Total Revenue$10,117,617CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,385,277PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,188,079CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,832,663PYOtherExpensesAmt
CY Other Expenses$2,978,290CYOtherExpensesAmt
PY Total Expenses$9,217,940PYTotalExpensesAmt
CY Total Expenses$9,166,369CYTotalExpensesAmt
PY Revenues Less Expenses$1,906,270PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$951,248CYRevenuesLessExpensesAmt
Total Assets BOY$14,083,373TotalAssetsBOYAmt
Total Assets EOY$10,633,683TotalAssetsEOYAmt
Total Liabilities BOY$6,285,681TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,098,096TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,797,692NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$6,535,587NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE NURSING AND RESPIRATORY CARE TO THOSE WHO REQUIRE FREQUENT SKILLED NURSING AND RESPIRATORY INTERVENTION.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$8,979,319ExpenseAmt
Revenue$10,081,164RevenueAmt
DescARIZONA'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.Desc
Total Program Service Expenses$8,979,319TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document4IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee179EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldAZStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THE ORGANIZATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6022434231PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 EAST SOUTH MOUNTAIN AVENUEAddressLine1Txt
CityPHOENIXCityNm
State AbbreviationAZStateAbbreviationCd
ZIP85042ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
GARY ORMAN
PRESIDENT1.002.00Yes (X)Yes (X)$0$0$0
TOM POMEROY
EXECUTIVE VICE PRESIDENT1.002.00Yes (X)Yes (X)$0$0$0
PATRICK WALSH
VICE PRESIDENT1.002.00Yes (X)Yes (X)$0$0$0
RALPH WALLWORK
TREASURER1.002.00Yes (X)Yes (X)$0$0$0
KATHRYN L DEL REAL
SECRETARY1.002.00Yes (X)Yes (X)$0$0$0
DICK KAUPIE
BOARD MEMBER0.501.00Yes (X)$0$0$0
KEVIN BERGER
BOARD MEMBER0.501.00Yes (X)$0$0$0
THOM NIEMIEC
BOARD MEMBER0.501.00Yes (X)$0$0$0
MIKE WADE
BOARD MEMBER0.501.00Yes (X)$0$0$0
WILLIAM TIMMONS
CHIEF EXECUTIVE OFFICER10.0030.00Yes (X)$0$511,474$26,197
DANI AALFS
CHIEF OPERATIONS OFFICER10.0030.00Yes (X)$0$109,080$13,214
JOSEPH O'MALLEY
CHIEF FINANCIAL OFFICER10.0030.00Yes (X)$0$189,183$16,990
KEVIN PAYNE
CHIEF OPERATING OFFICER OPERATIONS10.0030.00Yes (X)$0$139,287$12,683
PERRY PETRILLI
VP-RESIDENTAL SERVICES10.0030.00$0$156,551$6,032Yes (X)
ROXANNE ROSE
ADMIN DIRECTOR OF NURSING40.000.00$126,052$0$6,032Yes (X)
JANET LOVELADY
DIRECTOR OF NURSING40.000.00$139,150$0$5,566Yes (X)
JOHN WIDDER
DIRECTOR HOME MEDICAL SERVICES0.0040.00$0$135,574$10,000Yes (X)
DAVENA BALLARD
DIRECTOR SYNAGIS0.0040.00$0$131,666$10,966Yes (X)
HEATHER TEAFORD
ICF RN0.0040.00$0$128,940$13,394Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$265,202TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,501,755TotReportableCompRltdOrgAmt
Total Other Compensation$121,074TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
LOS NINOS HOSPITAL INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042NURSING REGISTRY AND THERAPY SERVICES$523,975
HACIENDA INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042MANAGMENT SERVICES$159,300
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
All Other Contributions$34,972AllOtherContributionsAmt
Noncash Contributions$17,525NoncashContributionsAmt
Total Contributions$34,972TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PRIVATE PATIENT SERVICE REVENUES623000$9,009,122$9,009,122
GOVERNMENT PATIENT SERVICE REVENU623000$373,016$373,016
NURSING FACILITY SUPPLEMENTS623000$317,853$317,853
PROGRAM RENTAL INCOME532000$314,365$314,365
OVERPAYMENTS - INSURANCE623000$66,808$66,808
FieldValueIRS element (for citing)
Total Program Service Revenue$10,081,164TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,481TotalRevenueColumnAmt
Exclusion$1,481ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,117,617TotalRevenueColumnAmt
Related Or Exempt Func Income$10,081,164RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,481ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,313,179TotalAmt
Program Services$5,313,179ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$79,900TotalAmt
Program Services$79,900ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$331,392TotalAmt
Program Services$331,392ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$463,608TotalAmt
Program Services$463,608ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$159,300TotalAmt
Management And General$159,300ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$17,750TotalAmt
Management And General$17,750ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$599,015TotalAmt
Program Services$599,015ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$7,878TotalAmt
Program Services$7,878ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,183TotalAmt
Program Services$3,183ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$276,197TotalAmt
Program Services$276,197ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$101,335TotalAmt
Program Services$101,335ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$338,611TotalAmt
Program Services$338,611ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$284,101TotalAmt
Program Services$284,101ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
SUPPLIES$455,272$455,272
MEDICAL EQUIPMENT$246,385$246,385
BED TAX EXPENSE$181,425$181,425
FOOD$173,307$173,307

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$134,531TotalAmt
Program Services$124,531ProgramServicesAmt
Management And General$10,000ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$9,166,369TotalAmt
Program Services$8,979,319ProgramServicesAmt
Management And General$187,050ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$700BOYAmt
EOY$6,596EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,296,390BOYAmt
EOY$1,548,910EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$5,813BOYAmt
EOY$2,558EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$2,196BOYAmt
EOY$2,055EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$11,555,740LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,647,478LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,219,219BOYAmt
EOY$8,908,262EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$157,044BOYAmt
EOY$165,302EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,402,011BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$14,083,373BOYAmt
EOY$10,633,683EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$489,874BOYAmt
EOY$444,865EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$4,255,373BOYAmt
EOY$3,653,231EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,540,434BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,285,681BOYAmt
EOY$4,098,096EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,416,422BOYAmt
EOY$6,285,267EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$381,270BOYAmt
EOY$250,320EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,797,692BOYAmt
EOY$6,535,587EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,083,373BOYAmt
EOY$10,633,683EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$951,248ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$8,225NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$2,221,578OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$204,464CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$420,618CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$49,704CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,607,842CurrentTaxYearMinus1YearAmt
Current Tax Year$34,972CurrentTaxYearAmt
Total$2,317,600TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,598,206CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,037,896CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,879,929CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$9,198,450CurrentTaxYearMinus1YearAmt
Current Tax Year$10,081,164CurrentTaxYearAmt
Total$43,795,645TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,802,670CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,458,514CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,929,633CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$10,806,292CurrentTaxYearMinus1YearAmt
Current Tax Year$10,116,136CurrentTaxYearAmt
Total$46,113,245TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$265,600CurrentTaxYearMinus3YearsAmt
Total$265,600TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$265,600CurrentTaxYearMinus3YearsAmt
Total$265,600TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$45,847,645PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,003CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$671CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$13,250CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,252CurrentTaxYearMinus1YearAmt
Current Tax Year$1,481CurrentTaxYearAmt
Total$18,657TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,003CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$671CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$13,250CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,252CurrentTaxYearMinus1YearAmt
Current Tax Year$1,481CurrentTaxYearAmt
Total$18,657TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,804,673CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,459,185CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,942,883CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$10,807,544CurrentTaxYearMinus1YearAmt
Current Tax Year$10,117,617CurrentTaxYearAmt
Total$46,131,902TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99380PublicSupportCY509Pct
Public Support PY5090.98660PublicSupportPY509Pct
Investment Income CY0.00040InvestmentIncomeCYPct
Investment Income PY0.00050InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,204,689OtherCostOrOtherBasisAmt
Depreciation$1,789,801DepreciationAmt
Book Value$7,414,888BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$199,791OtherCostOrOtherBasisAmt
Depreciation$66,075DepreciationAmt
Book Value$133,716BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$540,397OtherCostOrOtherBasisAmt
Depreciation$412,004DepreciationAmt
Book Value$128,393BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,610,863OtherCostOrOtherBasisAmt
Depreciation$379,598DepreciationAmt
Book Value$1,231,265BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$8,908,262TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$10,125,842TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$8,225NetUnrealizedGainsInvstAmt
Revenue Not Reported$8,225RevenueNotReportedAmt
Revenue Subtotal$10,117,617RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$10,117,617TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$9,166,369TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$9,166,369ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$9,166,369TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE 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, 2015, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
WILLIAM TIMMONS
CHIEF EXECUTIVE OFFICER$0$451,474$0$60,000$0$0$0$16,770$0$9,427$0$537,671$0$0
JOSEPH O'MALLEY
CHIEF FINANCIAL OFFICER$0$170,756$0$18,427$0$0$0$6,051$0$10,939$0$206,173$0$0
KEVIN PAYNE
CHIEF OPERATING OFFICER OPERATIONS$0$126,525$0$12,762$0$0$0$5,675$0$7,008$0$151,970$0$0
PERRY PETRILLI
VP-RESIDENTAL SERVICES$0$142,274$0$14,277$0$0$0$6,032$0$0$0$162,583$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15THE BOARD OF DIRECTORS DETERMINES REASONABLE AND APPROPRIATE SALARIES FOR KEY EMPLOYEES OF THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION GENERALLY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VIIHACIENDA 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 TO AFFILIATES -2,221,578.
FORM 990, PART XII, LINE 2C:THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
HACIENDA HEALTHCARE
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042272988610BRAND NAME FOR RELATED ORGAIZATIONSAZ501(C)(3)LINE 9N/A0
HACIENDA INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042860253158NURSING CARE & RESPIRATORY INTERVENTIONAZ501(C)(3)LINE 9N/A0
LOS NINOS HOSPITAL INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042860892673NON-PROFIT CHILDREN'S HOSPITALAZ501(C)(3)LINE 9N/A0
HACIENDA CHILDRENS HOSPITAL INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042473035370NON-PROFIT CHILDREN'S HOSPITALAZ501(C)(3)LINE 9N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
SOUTH MOUNTAIN HEALTH SUPPLY
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042860858893MEDICAL SUPPLY COMPANYAZHACIENDA HEALTHCAREC0
INNOVATIVE HOME HEALTH INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042262398755HOME HEALTH NURSING SERVICESAZHACIENDA HEALTHCAREC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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