2014-05-13T17:31:23-05:00 2013-06-30 860133881 HENRY & HORNE LLP 2055 E WARNER RD STE 101 TEMPE AZ 85284 990 2012-07-01 860892673 LOS NINOS HOSPITAL INC LOSN 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 WILLIAM TIMMONS 6022434231 2014-05-13 1 COLETTE KAMPS P00367616 4808394900 2014-05-13 2012 2015-11-30 17:44:51Z WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 27426646 0 X WWW.HACIENDAHEALTHCARE.ORG X 1997 AZ CHILDREN'S HOSPITAL SERVING THE NEEDS OF ACUTE AND CHRONICALLY ILL PATIENTS. 10 10 212 11 0 0 6897 1628014 16367112 17252217 684594 539596 24975 32137 17083578 19451964 0 0 0 0 7053921 7164353 0 0 0 6939834 7270201 13993755 14434554 3089823 5017410 30353328 35657065 2641156 678235 27712172 34978830 X TO PROVIDE ACUTE AND SUBACUTE HOSPITAL CARE TO INFANTS, CHILDREN AND TEENS. 0 0 2846116 3089931 INPATIENT: INPATIENT CARE IS A 15-BED, FAMILY ORIENTED HOSPITAL SPECIALIZING IN HIGH QUALITY ACUTE AND SUB-ACUTE CARE FOR INFANTS, CHILDREN AND TEENS. 3041435 3879266 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. 4151837 5702006 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. 3552821 4613151 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.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. 3552821 4613151 13592209 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 0 0 0 0 0 1 0 0 0 1 2 0 212 1 0 0 0 0 0 0 0 0 0 0 X 10 10 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 THOM NIEMIEC 1.00 X 0 0 0 PATRICK WALSH 1.00 X 0 0 0 KEVIN BERGER 1.00 X 0 0 0 MIKE WADE 1.00 X 0 0 0 KATHRYN L DEL REAL 1.00 X 0 0 0 PATRICIA SHAW 1.00 X 0 0 0 DICK KAUPIE 2.00 X X 0 0 0 TOM POMEROY 2.00 X X 0 0 0 GARY ORMAN 2.00 X X 0 0 0 RALPH WALLWORK 2.00 X X 0 0 0 WILLIAM TIMMONS 1.00 40.00 X 0 417717 21473 DALE SKURDAHL 1.00 40.00 X 0 207885 31787 PERRY F PETRILLI 1.00 40.00 X 0 142984 6030 DAVENA BALLARD 40.00 X 116105 0 12699 JOSEPH O'MALLEY 1.00 40.00 X 0 152796 15915 JOHN WIDDER 40.00 X 119640 0 11470 PAULINE ZAUTKE 40.00 X 104226 0 3870 339971 921382 103244 3 0 1 0 HACIENDA INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 MANAGEMENT FEES 636000 1 1610491 17523 3772 1628014 NET PATIENT FEES- PRIVATE 623990 12314249 12314249 NET PATIENT FEES- GOVERNMENT 623990 3687678 3687678 DSH REVENUE 621610 760204 760204 THERAPY INCOME FROM RELATED AFFIL 621610 490086 490086 17252217 47243 47243 8467035 7974682 492353 492353 492353 MISCELLANEOUS 900099 32137 32137 32137 19451964 17284354 0 539596 6101590 6101590 121541 121541 552084 545381 6703 389138 389138 636001 636001 17583 17583 226557 226557 17654 17654 14540 14540 513682 506297 7385 32380 32380 248345 248345 239252 239252 SUPPLIES 4860606 4860606 EQUIPMENT EXPENSE 201261 130141 71120 MISCELLANEOUS 151203 47705 103498 FLEET EXPENSES 41551 41551 69586 69531 55 14434554 13592209 842345 0 5721530 8909524 1427742 2930057 1599272 850135 31590 27828 5862049 3594468 1967364 2267581 15327806 14721240 4278024 5950700 30353328 35657065 659848 610496 1879947 101361 67739 2641156 678235 X 27709813 34776471 2359 202359 27712172 34978830 30353328 35657065 5017410 369301 1879947 0 X 0 1 X 1 0 X 160496 1957 283812 1886844 1628014 3961123 17102257 17295035 17087890 16930212 17252217 85667611 17262753 17296992 17371702 18817056 18880231 89628734 0 0 0 89628734 91250 53657 284747 387172 539596 1356422 91250 53657 284747 387172 539596 1356422 38196 24975 32137 95308 17354003 17350649 17694645 19229203 19451964 91080464 0.98410 0.98890 0.01490 0.01040 X 795024 795024 290478 171131 119347 4033099 3423337 609762 743448 743448 2267581 DUE FROM RELATED AFFILIATES 5950700 5950700 CAPITAL LEASE 67739 67739 X 19821265 369301 369301 19451964 0 19451964 14434554 0 14434554 0 14434554 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013, 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 0 13246343 13246343 0.91770 13246343 13246343 0.91770 13246343 13246343 0.91770 1 17548 262305 134090 128215 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 0 1 0 0 0 0 0 0 0 WILLIAM TIMMONS 0 382717 0 35000 0 0 0 14303 0 7170 0 439190 0 0 DALE SKURDAHL 0 199885 0 8000 0 0 0 8971 0 22816 0 239672 0 0 JOSEPH O'MALLEY 0 139910 0 12886 0 0 0 0 0 15915 0 168711 0 0 SUPPLEMENTAL INFORMATION PART III CERTAIN EMPLOYEES PARTICIPATE IN A 457B PLAN. AMOUNTS CONTRIBUTED BY EMPLOYEES DURING CALENDAR YEAR 2012 ARE AS FOLLOWS: WILLIAM TIMMONS - $22,500 DALE SKURDAHL - $20,075 SOUTH MOUNTAIN HEALTH SUPPLY INC(SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION 989098 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 33622 LOS NINOS HOSPITAL LEASES EQUIPMENT 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. COMPENSATION FROM RELATED ORGANIZATION 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. 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