2013-05-14T09:47:16-05:00 2012-06-30 860133881 HENRY & HORNE LLP 2055 E WARNER RD STE 101 TEMPE AZ 85284 990 2011-07-01 860253158 HACIENDA INC HACI 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 WILLIAM TIMMONS 6022434231 2013-05-13 1 COLETTE KAMPS P00367616 4808394900 2013-05-13 2011 2016-02-24 21:20:13Z WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 16223871 0 X WWW.HACIENDAHEALTHCARE.ORG X 1970 AZ PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 9 9 397 2800 0 0 147380 70656 15115861 15228068 0 1880 950541 923267 16213782 16223871 0 0 0 0 12426978 12181623 0 0 0 4312113 4192274 16739091 16373897 -525309 -150026 4720674 4664067 6168075 6158648 -1447401 -1494581 X PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 0 0 10551464 11328315 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. 298318 297350 EARLY 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. 3065193 3315717 GROUP 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. 317787 1209953 THE ORGANIZATION OPERATES A DAY TREATMENT AND TRAINING PROGRAM IN PHOENIX, ARIZONA FOR ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. 317787 1209953 14232762 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 1 0 1 0 0 0 0 0 1 0 0 0 0 1 18 0 397 1 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 THOM NIEMIEC 1.00 X 0 0 0 PATRICK WALSH 1.00 X 0 0 0 WANDA O'MALLEY 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 BARRY GOLDSTIN 2.00 X X 0 0 0 WILLIAM TIMMONS 40.00 X 346827 0 30244 DALE SKURDAHL 40.00 X 195761 0 42730 PERRY F PETRILLI 40.00 X 116004 0 15652 JOSEPH O'MALLEY 40.00 X 108158 0 15485 JANET LOVELADY 40.00 X 123311 0 9853 890061 0 113964 5 0 1 0 HACIENDA SKILLED NURSING FACILITY INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85040 RENT 300742 1 27193 43463 10324 70656 GOVERNMENT REVENUE 623990 14818725 14818725 PRIVATE SECTOR REVENUE 623990 409343 409343 15228068 1880 1880 MANAGEMENT FEES 623990 895220 895220 MEALS AND MISCELLANEOU 623990 28047 28047 923267 16223871 16151335 0 1880 998963 998963 9197901 8413208 784693 256953 228688 28265 1029771 1003193 26578 698035 621251 76784 135191 100333 34858 108000 108000 233249 166305 66944 28295 23961 4334 26317 20249 6068 729744 723273 6471 13301 10583 2718 302447 297887 4560 471598 451918 19680 SUPPLIES 1340081 1328478 11603 EQUIPMENT EXPENSE 244383 210215 34168 OTHER OPERATING EXPENSE 181033 156792 24241 FLEET EXPENSE 148181 148181 230454 220247 10207 16373897 14232762 2141135 0 4960 27998 1295398 1270524 124814 146292 260287 270927 6083828 3708533 2510220 2375295 452882 524265 72113 48766 4720674 4664067 1444948 971158 217763 212539 4505364 4974951 6168075 6158648 X -1516417 -1569243 65816 71462 3200 3200 -1447401 -1494581 4720674 4664067 X -150026 102846 X X 0 1 1 X 0 X 199002 452287 256374 147380 70656 1125699 13675375 15149597 14574467 16004859 16151219 75555517 13874377 15601884 14830841 16152239 16221875 76681216 0 0 0 76681216 144505 145879 182117 472501 -1203 -20054 -39534 -60791 144505 144676 162063 -39534 411710 14018882 15746560 14992904 16112705 16221875 77092926 0.99470 0.99330 0.00530 0.00670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 108000 108000 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THIRD PARTY LOBBYIST 74000 74000 3989796 2042078 1947718 2020032 1666455 353577 2375295 DUE TO RELATED AFFILIATE 3354549 DEFERRED COMPENSATION LIABILITY 520402 LINE OF CREDIT 1100000 4974951 16223871 16373897 -150026 -150026 16223871 0 16223871 0 16223871 16373897 0 16373897 0 16373897 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2012, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. X 0 1 0 0 0 0 0 0 0 WILLIAM TIMMONS 346827 0 0 0 0 0 22000 0 8244 0 377071 0 0 0 DALE SKURDAHL 195761 0 0 0 0 0 21205 0 21525 0 238491 0 0 0 SUPPLEMENTAL INFORMATION PART III 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 - $22,000 DALE SKURDAHL - $22,000 JANET LOVELADY - $ 1,350 SOUTH MOUNTAIN HEALTH SUPPLY INC (SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION 1256846 THE FILING ORGANIZATION PURCHASES HEALTH CARE SUPPLIES FROM SMHS. 0 PETER RANKE FORMER BOARD MEMBER 17412 FINANCIAL CONSULTING SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11 THE 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS AND CEO REVIEW THE FINANCIAL STATEMENTS AND OVERSEE THE AUDIT PROCESS. 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 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 1 1 1 1 1 0 1 0 0