2015-05-12T16:01:21-05:00 2014-06-30 860133881 HENRY & HORNE LLP 2055 E WARNER RD STE 101 TEMPE AZ 85284 990 2013-07-01 860253158 HACIENDA INC HACI 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 WILLIAM TIMMONS CEO 6022434231 2015-05-11 1 COLETTE KAMPS CPA P00367616 4808394900 2015-05-11 2013 2016-03-07 17:11:31Z WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 20773814 0 X WWW.HACIENDAHEALTHCARE.ORG X 1970 AZ PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 9 9 459 15 0 0 230153 775806 14894467 19960397 5810 6912 119009 30699 15249439 20773814 0 0 0 0 11940640 14674505 0 0 0 4387734 4701167 16328374 19375672 -1078935 1398142 4943675 6242971 7504761 7391509 -2561086 -1148538 X PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 0 0 11509145 15026818 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. 3833102 4399960 GROUP HOMES AND MEDICAL GROUP HOMES: THE ORGANIZATION OPERATES SEVEN GROUP HOMES IN THE COMMUNITY; FIVE THAT ARE MEDICAL FACILITIES AND TWO TRADITIONAL GROUP HOMES. 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 NURSES AND SUPERVISION BY A REGISTERED NURSE. THE INDIVIDUALS IN THESE HOMES REQUIRE SPECIFIC MEDICAL SUPERVISION BY TRAINED PERSONNEL. 481413 564318 THE ORGANIZATION OPERATES A DAY TREATMENT AND TRAINING PROGRAM IN PHOENIX, ARIZONA FOR ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. 15823660 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 14 0 459 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 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 DICK 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 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 40.00 X 461913 0 25574 DALE SKURDAHL CHIEF OPERATIONS OFFICER M 40.00 X 158593 0 27773 JOSEPH O'MALLEY CFO 40.00 X 182118 0 16817 PERRY F PETRILLI VP- RESIDENTIAL SERVICES 40.00 X 149936 0 6586 JANET LOVELADY DIRECTOR OF NURSING 40.00 X 139140 0 9493 LEAH SHALER VP-HEALTHCARE SUPPORT SERVCIES 40.00 X 135546 0 23437 HEATHER TEARFORD ICF RN 40.00 X 137912 0 10060 KEVIN PAYNE DIRECTOR OF INFORMATION TECHNOLOGY 40.00 X 124775 0 11102 1489933 0 130842 12 0 1 0 0 35925 739881 442366 775806 GOVERNMENT PATIENT SERVICE REVENU 623990 18660707 18660707 MANAGEMENT FEE 561000 959906 959906 PRIVATE PATIENT SERVICE REVENUE 623990 339784 339784 19960397 6912 6912 MEALS AND MISCELLANEOUS 623990 30699 30699 30699 20773814 19991096 0 6912 802739 802739 11629996 9462638 2167358 239360 193882 45478 1035070 838407 196663 967340 783545 183795 7541 6010 1531 31820 31820 215350 215350 182339 170992 11347 37904 32116 5788 21366 17614 3752 784506 778203 6303 3091 2651 440 315633 313112 2521 516970 503494 13476 SUPPLIES 1716474 1694635 21839 EQUIPMENT EXPENSE 255679 232775 22904 OTHER OPERATING EXPENSE 194853 171176 23677 FLEET EXPENSE 176759 176759 240882 230301 10581 19375672 15823660 3552012 0 27142 5760 70968 383849 1214345 1792186 149193 145081 365024 418014 6835104 4286230 2343058 2548874 738765 815592 35180 133615 4943675 6242971 1062083 1598224 206757 199704 6235921 5593581 7504761 7391509 X -2683768 -1969304 119482 817566 3200 3200 -2561086 -1148538 4943675 6242971 1398142 14406 0 X X 0 1 X 1 0 X 256374 147380 70656 230153 775806 1480369 14574467 16004859 16151219 15013476 19991096 81735117 14830841 16152239 16221875 15243629 20766902 83215486 0 0 0 83215486 182117 5810 6912 194839 182117 5810 6912 194839 15012958 16152239 16221875 15249439 20773814 83410325 0.99770 0.99650 0.00230 0.00350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 215350 215350 0 PART II-B, LINE 1: THIRD PARTY LOBBYIST 74000 74000 4344479 2243996 2100483 2416625 2042234 374391 2548874 DUE TO RELATED AFFILIATE 4954150 DEFERRED COMPENSATION LIABILITY 639431 5593581 X 19828314 14406 14406 19813908 959906 959906 20773814 18415766 0 18415766 959906 959906 19375672 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES 959,906. PART XII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES 959,906. X X 0 1 0 0 0 0 0 0 0 WILLIAM TIMMONS CHIEF EXECUTIVE OFFICER 411913 0 50000 0 0 0 15200 0 10374 0 487487 0 0 0 DALE SKURDAHL CHIEF OPERATIONS OFFICER M 158593 0 0 0 0 0 6666 0 21107 0 186366 0 0 0 JOSEPH O'MALLEY CFO 164400 0 17718 0 0 0 0 0 16817 0 198935 0 0 0 PERRY F PETRILLI VP- RESIDENTIAL SERVICES 136208 0 13728 0 0 0 5869 0 717 0 156522 0 0 0 LEAH SHALER VP-HEALTHCARE SUPPORT SERVCIES 121818 0 13728 0 0 0 4490 0 18947 0 158983 0 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 1587875 THE FILING ORGANIZATION PURCHASES HEALTH CARE SUPPLIES FROM SMHS. 0 X 47881 THRIFT STORE VALUE X 8 380099 FAIR MARKET VALUE X CHRISTMAS GIF 1 11767 FAIR MARKET VALUE X TICKETS 4 2619 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 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 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 0 1 0 0 0 0 0 1 1 1 1 1 0 1 0 1