2015-05-15T16:11:25-05:00 2014-06-30 860133881 HENRY & HORNE LLP 2055 E WARNER RD STE 101 TEMPE AZ 85284 990 2013-07-01 860892673 LOS NINOS HOSPITAL INC LOSN 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 WILLIAM TIMMONS CEO 6022434231 2015-05-14 1 COLETTE KAMPS CPA P00367616 4808394900 2015-05-14 2013 2016-02-25 16:41:14Z WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 29617604 0 X WWW.HACIENDAHEALTHCARE.ORG X 1997 AZ CHILDREN'S HOSPITAL SERVING THE NEEDS OF ACUTE AND CHRONICALLY ILL PATIENTS. 9 9 216 15 0 0 1628014 44965 17252217 15697744 539596 2580853 32137 48933 19451964 18372495 0 0 0 0 7164353 6829025 0 0 0 7270201 6558855 14434554 13387880 5017410 4984615 35657065 46291836 678235 5284335 34978830 41007501 X TO PROVIDE ACUTE AND SUBACUTE HOSPITAL CARE TO INFANTS, CHILDREN AND TEENS. 0 0 2559666 2006882 INPATIENT -INPATIENT CARE IS A 15-BED, FAMILY ORIENTED HOSPITAL SPECIALIZING IN HIGH QUALITY ACUTE AND SUB-ACUTE CARE FOR INFANTS, CHILDREN AND TEENS. 3005778 3541286 HOME HEALTH CARE: HOME HEALTH CARE SPECIALIZES IN THE CARE OF INFANTS, CHILDREN AND ADULTS WITH SPECIAL HEALTH CARE NEEDS REQUIRING HOME HEALTH CARE FROM NURSES AND THERAPISTS WITH SPECIAL TRAINING. 3028446 4580607 OUTPATIENT AND SYNAGIS CLINICS: THE ORGANIZATION OPERATES SIX OUTPATIENT SYNAGIS CLINICS LOCATED IN ARIZONA AND COLORADO. SYNAGIS IS AN INJECTABLE USED TO IMMUNIZE INFANTS AND YOUNG CHILDREN AGAINST RESPIRATORY SYNCYTIAL VIRUS (RSV). THE CLINICS ARE OPEN FROM NOVEMBER TO APRIL EACH YEAR, WHICH IS THE HIGH SEASON FOR RSV. 2099167 2895231 VENTILATOR PROGRAM: THE VENTILATOR PROGRAM ENABLES VENTILATOR DEPENDENT INDIVIDUALS TO FUNCTION IN SOCIETY AT THE OPTIMAL LEVEL OF THEIR CAPABILITIES AND POTENTIAL BY COMBINING TECHNOLOGY, SERVICES AND MEDICAL SUPPLIES. THIS IS ACHIEVED BY PROVIDING PRODUCTS, EDUCATION, TRAINING AND ON-GOING MONITORING OF EQUIPMENT. THE VENTILATOR PROGRAM PROVIDES SERVICE ON VENTILATORS AND OTHER MEDICAL EQUIPMENT IN PATIENTS' HOMES, AS WELL AS A HOME ENTERAL FEEDING SERVICE THAT SERVES THE NUTRITIONAL NEEDS OF MEDICALLY FRAGILE PATIENTS BY PROVIDING FORMULA AND SUPPLIES. 1768916 2722671 THERAPY SERVICES: THERAPY SERVICES PROVIDE PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY TO INFANTS, CHILDREN AND ADULTS. SERVICES ARE PROVIDED IN BOTH INPATIENT AND OUTPATIENT SETTINGS, INCLUDING HOME HEALTH CARE. THESE SERVICES INCLUDE EVALUATIONS, CONSULTATIONS, INTERVENTION, SKILLED HANDS-ON CARE, ADAPTIVE EQUIPMENT AND FAMILY/CAREGIVER TRAINING.REGISTRY SERVICES: INNOVATIVE STAFFING, BEGAN IN 2005, PROVIDES STAFFING NEEDS TO FILL VACANT POSITIONS AND OPEN SHIFTS WITH MEDICAL PROFESSIONALS INCLUDING REGISTERED NURSES, LICENSED PRACTICAL NURSES, CERTIFIED NURSING ASSISTANTS, CAREGIVERS AND RESPIRATORY THERAPISTS.NURSE CONSULTING: THE ORGANIZATION CONTRACTS WITH THE DIVISION OF DEVELOPMENTAL DISABILITIES (DDD), A DIVISION OF THE ARIZONA DEPARTMENT OF ECONOMIC SECURITY, FOR CERTAIN SPECIALIZED CLINICAL CONSULTING SERVICES. UNDER THE ARRANGEMENT AND ON BEHALF OF DDD, QUALIFIED NURSING PERSONNEL EMPLOYED BY THE ORGANIZATION ASSESS AND MONITOR NURSING SERVICES RENDERED BY VARIOUS PROVIDERS OF SERVICES TO DEVELOPMENTALLY DISABLED CONSUMERS IN ARIZONA. SUCH SERVICES INCLUDE THOSE PROVIDED IN A CONSUMER'S HOME, A GROUP HOME, A DEVELOPMENTAL HOME, A LEVEL II OR LEVEL III BEHAVIORAL HEALTH FACILITY AND ANY DAY CARE PROGRAM. 3868083 5617902 12461973 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 7 0 216 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 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 X GARY ORMAN PRESIDENT 2.00 X X 0 0 0 TOM POMEROY EXECUTIVE VICE PRESIDENT 2.00 X X 0 0 0 PATRICK WALSH VICE PRESIDENT 2.00 X X 0 0 0 RALPH WALLWORK TREASURER 2.00 X X 0 0 0 KATHRYN L DEL REAL SECRETARY 2.00 X X 0 0 0 DICKE KAUPIE BOARD MEMBER 1.00 X 0 0 0 KEVIN BERGER BOARD MEMBER 1.00 X 0 0 0 THOM NIEMIEC BOARD MEMBER 1.00 X 0 0 0 MIKE WADE BOARD MEMBER 1.00 X 0 0 0 DALE SKURDAHL CHEIF OPERATIONS OFFICER 10.00 30.00 X 0 158593 27773 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 10.00 30.00 X 0 461913 25574 JOSEPH O'MALLEY CFO 10.00 30.00 X 0 182118 16817 JOHN WIDDER DIRECTOR HOME MEDICAL SERVICES 40.00 X 122228 0 12566 DAVENA BALLARD DIRECTOR SYNAGIS 40.00 X 125577 0 14989 PAULINE ZAUTKE DIRECTOR OF HOME HEALTH SERVICES 40.00 X 101502 0 6204 PERRY PETRILLI VP-RESIDENTAL SERVICES 10.00 30.00 X 0 149936 6586 LEAH SHALER VP- HEALTHCARE SUPPORT SERVICES 10.00 30.00 X 0 135546 22262 349307 1088106 132771 3 0 1 0 HACIENDA INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 MANAGEMENT SERVICES 636000 1 44965 34948 44965 PRIVATE PATIENT REVENUE 623990 9698646 9698646 GOVERNMENT PATIENT REVENUE 623990 4110307 4110307 RETURN OF DSH REVENUE 621610 1383720 1383720 THERAPY INCOME FROM RELATED AFFIL 621610 505071 505071 15697744 373602 373602 13452360 11245109 2207251 2207251 2207251 MISCELLANEOUS 900099 48933 48933 48933 18372495 15746677 0 2580853 5780708 5780708 114274 114274 565032 565032 369011 369011 636003 636003 22074 22074 161330 161330 9788 9788 15051 15051 501875 467835 34040 24312 24312 230979 230979 260399 256724 3675 SUPPLIES 3735520 3734655 865 STAFF TRAINING 374440 374440 EQUIPMENT EXPENSE 268023 212433 55590 MISCELLANEOUS 225567 52096 173471 93494 93305 189 13387880 12461973 925907 0 8909524 11032176 2930057 1324854 850135 699032 27828 49292 6418414 3825446 2267581 2592968 14721240 27492361 5950700 3101153 35657065 46291836 610496 750641 4500000 67739 33694 678235 5284335 X 34776471 40999192 202359 8309 34978830 41007501 35657065 46291836 4984615 1044056 0 X X 0 1 X 1 0 X 1957 283812 1886844 1628014 44965 3845592 17295035 17087890 16930212 17252217 15697744 84263098 17296992 17371702 18817056 18880231 15742709 88108690 0 0 0 88108690 53657 284747 387172 539596 373602 1638774 53657 284747 387172 539596 373602 1638774 38196 24975 32137 48933 144241 17350649 17694645 19229203 19451964 16165244 89891705 0.98020 0.98410 0.01820 0.01490 X 795024 795024 633961 193281 440680 4225514 3632165 593349 763915 763915 2592968 DUE FROM AFFILIATES 3101153 3101153 CAPITAL LEASE 33694 33694 X 19416551 1044056 1044056 18372495 0 18372495 13387880 0 13387880 0 13387880 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, 2014, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. 1 1 1 X 1 X 1 0 0 10182338 10182338 0.76060 10182338 10182338 0.76060 10182338 10182338 0.76060 1 31984 407561 208345 199216 X 1 1 1 1 LOS NINOS HOSPITAL 2303 E THOMAS RD PHOENIX AZ 85016 X X LOS NINOS HOSPITAL INC 1 0 1 1 100.000000000000 1 200.000000000000 1 X X X X X 1 1 X X 1 X X X 0 X X 0 X X 0 0 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 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 4: AS DESCRIBED IN FORM 990, PART III, SUPPLEMENTED IN SCHEDULE O, LOS NINOS HOSPITAL PROVIDES A VARIETY OF CLINICAL PROGRAMS THAT ARE CRITICAL TO THE HEALTH OF INFANTS, CHILDREN AND YOUNG ADULTS WHO ARE CHRONICALLY ILL AND MEDICALLY FRAGILE. NEARLY ALL PATIENTS ARE COVERED BY GOVERNMENTAL HEALTH PROGRAMS, SUCH AS THE STATE OF ARIZONA'S DIVISION OF DEVELOPMENTAL DISABILITIES, THE ARIZONA MEDICAID PROGRAM (KNOWN AS AHCCCS), OR MEDICAID MANAGED CARE PLANS. AS A RESULT, FEW PATIENTS HAVE A NEED FOR CHARITY DISCOUNTS. THE LOS NINOS HOSPITAL INPATIENT UNIT PROVIDES ACUTE AND SUBACUTE HOSPITAL CARE TO INFANTS AND CHILDREN LESS EXPENSIVELY THAN LARGER ACCUTE CARE HOSPITALS. MEDICAL SERVICES PAYORS OFTEN REQUIRE THE TRANSFER OF PATIENTS TO LOS NINOS FROM MORE EXPENSIVE SETTINGS WHEN THEY'RE CLINICALLY APPROPRIATE, THEREBY SAVING SCARCE GOVERNMENT FUNDS. LOS NINOS HOSPITAL'S SIX SYNAGIS CLINICS PROTECT HIGH RISK INFANTS FROM CONTRACTING RESPRITORY SYNCYTIAL VIRUS, THEREBY SAVING LIVES AND MINIMIZING THE POTENTIAL FOR EXPENSIVE LIFE-LONG RESPIRATORY TREATMENT. LOS NINOS HOSPITAL'S HOME VENTILATOR PROGRAM AND HOME HEALTH SEVICES PROVIDE PATIENTS WITH EFFECTIVE HEALTH CARE IN THEIR HOMES, A FAR LESS EXPENSIVE SETTING THAN HOSPITALS, THEREBY FURTHER SAVING INCREASINGLY SCARCE GOVERNMENT FUNDS. X X 0 1 0 0 0 0 0 0 0 DALE SKURDAHL CHEIF OPERATIONS OFFICER 0 158593 0 0 0 0 0 6666 0 21107 0 186366 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 0 411913 0 50000 0 0 0 15200 0 10374 0 487487 0 0 JOSEPH O'MALLEY CFO 0 164400 0 17718 0 0 0 0 0 16817 0 198935 0 0 PERRY PETRILLI VP-RESIDENTAL SERVICES 0 136208 0 13728 0 0 0 5869 0 717 0 156522 0 0 LEAH SHALER VP- HEALTHCARE SUPPORT SERVICES 0 121818 0 13728 0 0 0 1350 0 20912 0 157808 0 0 FORM 990, SCHEDULE J, PART I, 4A CERTAIN EMPLOYEES PARTICIPATE IN A SECTION 457B PLAN. THE AMOUNTS CONTRIBUTED BY THESE EMPLOYEES ARE LISTED BELOW. THE ORGANIZATION DOES NOT MAKE EMPLOYER CONTRIBUTIONS TO THE ACCOUNTS IN THIS PLAN. WILLIAM TIMMONS - $17,500 DALE SKURDAHL - $14,135 JANET LOVELADY - $ 1,300 SOUTH MOUNTAIN HEALTH SUPPLY INC(SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION 10166440 LOS NINOS HOSPITAL PURCHASES HEALTH CARE SUPPLIES FROM SMHS. 0 SOUTH MOUNTAIN HEALTH SUPPLY INC (SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION 33694 LOS NINOS HOSPITAL LEASES EQUIPMENT FROM SMHS. 0 X 9798 THRIFT STORE VALUE X OFFICE EQUIPM 2 25150 FAIR VALUE 0 0 0 PART I, COLUMN (B): THE NUMBER IN ROW 25 COLUMN B REPRESENTS THE NUMBER OF ITEMS DONATED. 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 VII, LINE 1A LOS NINOS HOSPITAL, INC. IS RELATED TO TWO TAX EXEMPT AFFILIATES, HACIENDA, INC. AND HACIENDA SKILLED NURSING FACILITY, 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 XII, LINE 2C: THE PROCESS HAS NOT CHANGED 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 HACIENDA INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860253158 PROVIDE SERVICES FOR HANDICAPPED & CHRONICALLY ILL CHILDREN 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 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0