HACIENDA INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
HACIENDA INC (EIN 86-0253158)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201331349349301823
Schema version
2011v1.5
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)
Timestamp2013-05-14T09:47:16-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN860133881EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1HENRY & HORNE LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12055 E WARNER RD STE 101AddressLine1
CityTEMPECity
StateAZState
ZIP Code85284ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN860253158EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HACIENDA INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHACINameControl
Phone6022434231Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 E SOUTH MOUNTAIN AVENUEAddressLine1
CityPHOENIXCity
StateAZState
ZIP Code85040ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWILLIAM TIMMONSName
TitleCEOTitle
Phone6022434231Phone
Date Signed2013-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCOLETTE KAMPSName
PTINP00367616PTIN
Phone4808394900Phone
Date Prepared2013-05-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonWILLIAM TIMMONSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11402 E SOUTH MOUNTAIN AVENUEAddressLine1
CityPHOENIXCity
StateAZState
ZIP Code85040ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16223871GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HACIENDAHEALTHCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1970YearFormation
State Legal DomicileAZStateLegalDomicile
Activity Or Mission DescriptionPROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDRENActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees397TotalNbrEmployees
Total Nbr Volunteers2800TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year147380ContributionsGrantsPriorYear
Contributions Grants Current Year70656ContributionsGrantsCurrentYear
Program Service Revenue Prior Year15115861ProgramServiceRevenuePriorYear
Program Service Revenue CY15228068ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year1880InvestmentIncomeCurrentYear
Other Revenue Prior Year950541OtherRevenuePriorYear
Other Revenue Current Year923267OtherRevenueCurrentYear
Total Revenue Prior Year16213782TotalRevenuePriorYear
Total Revenue Current Year16223871TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12426978SalariesEtcPriorYear
Salaries Etc Current Year12181623SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4312113OtherExpensePriorYear
Other Expenses Current Year4192274OtherExpensesCurrentYear
Total Expenses Prior Year16739091TotalExpensesPriorYear
Total Expenses Current Year16373897TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-525309RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-150026RevenuesLessExpensesCY
Total Assets BOY4720674TotalAssetsBOY
Total Assets EOY4664067TotalAssetsEOY
Total Liabilities BOY6168075TotalLiabilitiesBOY
Total Liabilities EOY6158648TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-1447401NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-1494581NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDRENMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10551464Expense
Revenue11328315Revenue
DescriptionINTERMEDIATE 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense298318Expense
Revenue297350Revenue
DescriptionEARLY INTERVENTION: THE EARLY INTERVENTION PROGRAM WORKS WITH INFANTS AND TODDLERS AGES 0-3 WHO HAVE BEEN DIAGNOSED WITH A DEVELOPMENTAL DELAY OR DISABILITY OR HAVE BEEN IDENTIFIED AS BEING AT RISK FOR A DELAY OR DISABILITY IN THE FUTURE. DEVELOPMENTAL SPECIALISTS SERVE CHILDREN OF ALL LEVELS OF FUNCTIONING WITHIN AN EDUCATIONAL FRAMEWORK THAT HELPS CHILDREN ACHIEVE THEIR POTENTIALS, AS WELL AS MINIMIZE THE NEED FOR REMEDIAL SERVICES IN THE FUTURE.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3065193Expense
Revenue3315717Revenue
DescriptionGROUP HOMES AND MEDICAL GROUP HOMES: THE ORGANIZATION OPERATES FIVE GROUP HOMES IN THE COMMUNITY; THREE 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.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense317787Expense
Revenue1209953Revenue
DescriptionTHE ORGANIZATION OPERATES A DAY TREATMENT AND TRAINING PROGRAM IN PHOENIX, ARIZONA FOR ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp317787TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev1209953TotalOfOtherProgramServiceRev
Total Program Service Expense14232762TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109618NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees397NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledAZStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1THE ORGANIZATIONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6022434231TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11402 E SOUTH MOUNTAIN AVENUEAddressLine1
CityPHOENIXCity
StateAZState
ZIP Code85040ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
THOM NIEMIEC
BOARD MEMBER1.00X000
PATRICK WALSH
BOARD MEMBER1.00X000
WANDA O'MALLEY
BOARD MEMBER1.00X000
PATRICIA SHAW
BOARD MEMBER1.00X000
DICK KAUPIE
PRESIDENT2.00X000X
TOM POMEROY
EXECUTIVE VICE PRESIDENT2.00X000X
GARY ORMAN
VICE PRESIDENT2.00X000X
RALPH WALLWORK
TREASURER2.00X000X
BARRY GOLDSTIN
SECRETARY2.00X000X
WILLIAM TIMMONS
CHIEF EXECUTIVE OFFICER40.00346827030244X
DALE SKURDAHL
CHIEF OPERATIONS OFFICER M40.00195761042730X
PERRY F PETRILLI
VICE PRESIDENT - RESIDENT SERVICES40.00116004015652X
JOSEPH O'MALLEY
CONTROLLER/FINANCIAL ANALY40.00108158015485X
JANET LOVELADY
DIRECTOR OF NURSING40.0012331109853X
FieldValueIRS element (for citing)
Total Reportable Comp From Org890061TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation113964TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HACIENDA SKILLED NURSING FACILITY INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11402 E SOUTH MOUNTAIN AVEAddressLine1
CityPHOENIXCity
StateAZState
ZIP Code85040ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesRENTDescriptionOfServices
Compensation300742Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Federated Campaigns27193FederatedCampaigns
All Other Contributions43463AllOtherContributions
Noncash Contributions10324NoncashContributions
Total Contributions70656TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
GOVERNMENT REVENUE6239901481872514818725
PRIVATE SECTOR REVENUE623990409343409343
FieldValueIRS element (for citing)
Total Program Service Revenue15228068TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1880TotalRevenueColumn
Exclusion$1,880ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MANAGEMENT FEES623990895220895220
MEALS AND MISCELLANEOU6239902804728047
FieldValueIRS element (for citing)
Total Other Revenue923267TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column16223871TotalRevenueColumn
Related Or Exempt Function Income16151335RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,880ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total998963Total
Management And General998963ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9197901Total
Program Services8413208ProgramServices
Management And General784693ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total256953Total
Program Services228688ProgramServices
Management And General28265ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1029771Total
Program Services1003193ProgramServices
Management And General26578ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total698035Total
Program Services621251ProgramServices
Management And General76784ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total135191Total
Program Services100333ProgramServices
Management And General34858ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total108000Total
Program Services108000ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total233249Total
Program Services166305ProgramServices
Management And General66944ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total28295Total
Program Services23961ProgramServices
Management And General4334ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total26317Total
Program Services20249ProgramServices
Management And General6068ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total729744Total
Program Services723273ProgramServices
Management And General6471ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total13301Total
Program Services10583ProgramServices
Management And General2718ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total302447Total
Program Services297887ProgramServices
Management And General4560ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total471598Total
Program Services451918ProgramServices
Management And General19680ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES1340081132847811603
EQUIPMENT EXPENSE24438321021534168
OTHER OPERATING EXPENSE18103315679224241
FLEET EXPENSE148181148181

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total230454Total
Program Services220247ProgramServices
Management And General10207ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total16373897Total
Program Services14232762ProgramServices
Management And General2141135ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4960BOY
EOY27998EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1295398BOY
EOY1270524EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY124814BOY
EOY146292EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY260287BOY
EOY270927EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis6083828LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3708533LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2510220BOY
EOY2375295EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY452882BOY
EOY524265EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY72113BOY
EOY48766EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4720674BOY
EOY4664067EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1444948BOY
EOY971158EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY217763BOY
EOY212539EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4505364BOY
EOY4974951EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6168075BOY
EOY6158648EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-1516417BOY
EOY-1569243EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY65816BOY
EOY71462EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3200BOY
EOY3200EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-1447401BOY
EOY-1494581EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4720674BOY
EOY4664067EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-150026ReconcilationRevenueExpenses
Reconcilation Other Changes102846ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years199002CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years452287CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years256374CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year147380CurrentTaxYearMinus1Year
Current Tax Year70656CurrentTaxYear
Total1125699Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13675375CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15149597CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14574467CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16004859CurrentTaxYearMinus1Year
Current Tax Year16151219CurrentTaxYear
Total75555517Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13874377CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15601884CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14830841CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16152239CurrentTaxYearMinus1Year
Current Tax Year16221875CurrentTaxYear
Total76681216Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50976681216PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years144505CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years145879CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years182117CurrentTaxYearMinus2Years
Total472501Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years-1203CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years-20054CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year-39534CurrentTaxYearMinus1Year
Total-60791Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years144505CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years144676CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years162063CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year-39534CurrentTaxYearMinus1Year
Total411710Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14018882CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15746560CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14992904CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16112705CurrentTaxYearMinus1Year
Current Tax Year16221875CurrentTaxYear
Total77092926Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99470PublicSupportPercentage509
Prior Year Support Percentage0.99330PriorYearSupportPercentage
Investment Income Percentage0.00530InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00670PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$108,000OtherActivitiesAmount
Total Lobbying Expenditures IIB108000TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHIRD PARTY LOBBYISTExplanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis74000OtherCostOrOtherBasis
Book Value74000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3989796OtherCostOrOtherBasis
Depreciation2042078Depreciation
Book Value1947718BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2020032OtherCostOrOtherBasis
Depreciation1666455Depreciation
Book Value353577BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2375295TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DUE TO RELATED AFFILIATE$3,354,549
DEFERRED COMPENSATION LIABILITY$520,402
LINE OF CREDIT$1,100,000
FieldValueIRS element (for citing)
Total Of Amounts4974951TotalOfAmounts
Total Revenue16223871TotalRevenue
Total Expenses16373897TotalExpenses
Excess Or Deficit For Year-150026ExcessOrDeficitForYear
Excess Or Deficit Per FS-150026ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt16223871TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal16223871RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99016223871TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt16373897TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal16373897ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99016373897TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
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, 2012, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
WILLIAM TIMMONS
3468270000022000082440377071000
DALE SKURDAHL
19576100000212050215250238491000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationCERTAIN 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 - $22,000 DALE SKURDAHL - $22,000 JANET LOVELADY - $ 1,350Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
SOUTH MOUNTAIN HEALTH SUPPLY INC (SMHS)
OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION1256846THE FILING ORGANIZATION PURCHASES HEALTH CARE SUPPLIES FROM SMHS.0
PETER RANKE
FORMER BOARD MEMBER17412FINANCIAL CONSULTING SERVICES0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S CEO, TREASURER AND CONTROLLER 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 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 DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 5:PRIOR PERIOD ADJUSTMENT FOR DONATED VEHICLES RECEIVED IN PRIOR YEAR 102,846. TOTAL TO FORM 990, PART XI, LINE 5: 102,846.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2CTHE BOARD OF DIRECTORS AND CEO REVIEW THE FINANCIAL STATEMENTS AND OVERSEE THE AUDIT PROCESS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
HACIENDA HEALTHCARE
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042272988610BRAND NAME FOR RELATED ORGANIZATIONSAZ501(C)(3)LINE 9N/A0
HACIENDA SKILLED NURSING FACILITY INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042141906233NURSING 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

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
SOUTH MOUNTAIN HEALTH SUPPLY
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042860858893MEDICAL SUPPLY COMPANYAZHACIENDA HEALTHCAREC
INNOVATIVE HOME HEALTH INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042262398755HOME HEALTH NURSING SERVICESAZHACIENDA HEALTHCAREC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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