2016-05-16T16:28:20-05:00 2015-06-30 860133881 HENRY & HORNE LLP 2055 E WARNER RD STE 101 TEMPE AZ 85284 990 2014-07-01 860253158 HACIENDA INC HACI 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 WILLIAM TIMMONS CEO 6022434231 2016-05-13 1 COLETTE KAMPS CPA P00367616 4808394900 2016-05-13 2014 2016-08-17 19:52:53Z WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 20552620 0 X WWW.HACIENDAHEALTHCARE.ORG X 1970 AZ PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 9 9 500 15 0 0 775806 297094 19960397 20197313 6912 10593 30699 47620 20773814 20552620 0 0 0 0 14674505 15672873 0 0 0 4701167 5102591 19375672 20775464 1398142 -222844 6242971 6893997 7391509 2708829 -1148538 4185168 X PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 0 0 11296076 13577733 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. 4578811 5856599 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. 662768 810601 THE ORGANIZATION OPERATES A DAY TREATMENT AND TRAINING PROGRAM IN PHOENIX, ARIZONA FOR ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. 16537655 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 18 0 500 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 GARY ORMAN PRESIDENT 1.00 2.00 X X 0 0 0 TOM POMEROY EXECUTIVE VICE PRESIDENT 1.00 2.00 X X 0 0 0 PATRICK WALSH VICE PRESIDENT 1.00 2.00 X X 0 0 0 RALPH WALLWORK TREASURER 1.00 2.00 X X 0 0 0 KATHRYN L DEL REAL SECRETARY 1.00 2.00 X X 0 0 0 DICK KAUPIE 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 MIKE WADE BOARD MEMBER 0.50 1.00 X 0 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 20.00 20.00 X 511474 0 26197 DANI AALFS CHIEF OPERATIONS OFFICER ADMIN SERVICES 20.00 20.00 X 109080 0 13214 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 20.00 20.00 X 189183 0 16990 KEVIN PAYNE CHIEF OPERATING OFFICER OPERATIONS 20.00 20.00 X 139287 0 12683 PERRY F PETRILLI VP- RESIDENTIAL SERVICES 20.00 20.00 X 156551 0 6032 HEATHER TEARFORD ICF RN 40.00 0.00 X 128940 0 13394 JANET LOVELADY DIRECTOR OF NURSING 0.00 40.00 X 0 139150 5566 JOHN WIDDER DIRECTOR OF HOME MEDICAL SERVICES 0.00 40.00 X 0 135574 10000 DAVENA BALLARD DIRECTOR SYNAGIS 0.00 40.00 X 0 131666 10966 ROXANNE ROSE ADON 0.00 40.00 X 0 126052 6032 1234515 532442 121074 12 0 1 0 0 20299 276795 131722 297094 GOVERNMENT PATIENT SERVICE REVENU 623990 18932087 18932087 MANAGEMENT FEE 561000 972341 972341 PRIVATE PATIENT SERVICE REVENUE 623990 292885 292885 20197313 10593 10593 MEALS AND MISCELLANEOUS 623990 47620 47620 47620 20552620 20244933 0 10593 983878 983878 12090537 9597642 2492895 249753 197305 52448 1314262 1038267 275995 1034443 827554 206889 138003 105793 32210 31290 31290 223025 223025 104648 99439 5209 114596 102628 11968 25461 20243 5218 814034 805692 8342 4301 3755 546 345327 342424 2903 473240 453478 19762 SUPPLIES 1727538 1708203 19335 OTHER OPERATING EXPENSE 322802 275521 47281 EQUIPMENT EXPENSE 271079 244033 27046 FOOD 186025 185483 542 321222 307170 14052 20775464 16537655 4237809 0 5760 4954 383849 1792186 1839296 145081 152245 418014 467597 8024937 4457893 2548874 3567044 815592 666816 180105 133615 15940 6242971 6893997 1598224 1873888 199704 173688 5593581 661253 7391509 2708829 X -1969304 4123042 817566 58926 3200 3200 -1148538 4185168 6242971 6893997 X -222844 3794 5552756 X X 0 1 X 1 0 X 147380 70656 230153 775806 297094 1521089 16004859 16151219 15013476 19991096 20244933 87405583 16152239 16221875 15243629 20766902 20542027 88926672 0 0 0 88926672 5810 6912 10593 23315 5810 6912 10593 23315 16152239 16221875 15249439 20773814 20552620 88949987 0.99970 0.99770 0.00030 0.00230 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 223025 223025 0 PART II-B, LINE 1: THIRD PARTY LOBBYIST 74000 74000 5086658 2650265 2436393 2843763 1807628 1036135 20516 20516 3567044 DEFERRED COMPENSATION LIABILITY 661253 661253 X 20556414 3794 3794 20552620 0 20552620 20775464 0 20775464 0 20775464 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, 2015, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. X X 0 0 0 0 0 0 0 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 451474 0 60000 0 0 0 16770 0 9427 0 537671 0 0 0 JOSEPH O'MALLEY CHIEF FINANCIAL OFFICER 170756 0 18427 0 0 0 6051 0 10939 0 206173 0 0 0 KEVIN PAYNE CHIEF OPERATING OFFICER OPERATIONS 126525 0 12762 0 0 0 5675 0 7008 0 151970 0 0 0 PERRY F PETRILLI VP- RESIDENTIAL SERVICES 142274 0 14277 0 0 0 6032 0 0 0 162583 0 0 0 SOUTH MOUNTAIN HEALTH SUPPLY INC (SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION 1553363 THE FILING ORGANIZATION PURCHASES HEALTH CARE SUPPLIES FROM SMHS. 0 X TELEFLEX EQUIPMENT 1 56136 FAIR MARKET VALUE X TOYS AND CLOTHING 24 43235 FAIR MARKET VALUE X OFFICE FURNITURE 1 19850 FAIR MARKET VALUE X WHEELCHAIRS 2 9500 FAIR MARKET VALUE X TICKETS 1 2000 FAIR MARKET VALUE X ELECTRIC FIREPLACES 1 1000 FAIR MARKET VALUE 0 0 0 PART I, COLUMN (B): PART I, COLUMN B REPRESENTS THE NUMBER OF SEPARATE INSTANCES OF DONATIONS RECEIVED. 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: TRANSFER FROM AFFILIATE 5,552,756. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED THE PROCESS FROM THE PRIOR YEAR. HACIENDA HEALTHCARE 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 272988610 BRAND NAME FOR RELATED ORGANIZATIONS 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 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 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 0 1 0 1