HACIENDA SKILLED NURSING FACILITY INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
HACIENDA SKILLED NURSING FACILITY INC (EIN 14-1906233)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201341349349301584
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)
EIN141906233EIN

Name Name

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

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 EAST SOUTH MOUNTAIN AVENUEAddressLine1
CityPHOENIXCity
StateAZState
ZIP Code85042ZIPCode

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 EAST SOUTH MOUNTAIN AVENUEAddressLine1
CityPHOENIXCity
StateAZState
ZIP Code85042ZIPCode
FieldValueIRS element (for citing)
Gross Receipts8772416GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HACIENDAHEALTHCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileAZStateLegalDomicile
Activity Or Mission DescriptionSKILLED NURSING AND RESPIRATORY INTERVENTIONActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees177TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year204464ContributionsGrantsPriorYear
Contributions Grants Current Year420618ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7586675ProgramServiceRevenuePriorYear
Program Service Revenue CY8037896ProgramServiceRevenueCY
Investment Income Prior Year2003InvestmentIncomePriorYear
Investment Income Current Year671InvestmentIncomeCurrentYear
Other Revenue Prior Year11531OtherRevenuePriorYear
Other Revenue Current Year12489OtherRevenueCurrentYear
Total Revenue Prior Year7804673TotalRevenuePriorYear
Total Revenue Current Year8471674TotalRevenueCurrentYear
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 Year5046339SalariesEtcPriorYear
Salaries Etc Current Year5195378SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2696318OtherExpensePriorYear
Other Expenses Current Year2465838OtherExpensesCurrentYear
Total Expenses Prior Year7742657TotalExpensesPriorYear
Total Expenses Current Year7661216TotalExpensesCurrentYear
Revenues Less Expenses Prior Year62016RevenuesLessExpensesPriorYear
Revenues Less Expenses CY810458RevenuesLessExpensesCY
Total Assets BOY13626916TotalAssetsBOY
Total Assets EOY13507841TotalAssetsEOY
Total Liabilities BOY9918887TotalLiabilitiesBOY
Total Liabilities EOY8763257TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3708029NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4744584NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE NURSING AND RESPIRATORY CARE TO THOSE WHO REQUIRE FREQUENT SKILLED NURSING AND RESPIRATORY INTERVENTION.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7465096Expense
Revenue8037896Revenue
DescriptionARIZONA'S FIRST SKILLED NURSING FACILITY FOR INFANTS, CHILDREN, TEENS, AND YOUNG ADULTS. CARE FOR MEDICALLY FRAGILE PATIENTS WHO REQUIRE FREQUENT SKILLED NURSING AND RESPIRATORY INTERVENTIONS.Description
Total Program Service Expense7465096TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Assets1ReportOtherAssets
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 Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
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 With10967NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees177NumberOfEmployees
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 EAST SOUTH MOUNTAIN AVENUEAddressLine1
CityPHOENIXCity
StateAZState
ZIP Code85042ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

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 OFFICER40.00034682730244X
DALE SKURDAHL
CHIEF OPERATIONS OFFICER M40.00019576142730X
PERRY F PETRILLI
VICE PRESIDENT - RESIDENTIAL SERVICES40.00011600415652X
JOSEPH O'MALLEY
CONTROLLER/FINANCIAL ANALY40.00010815815485X
JANET LOVELADY
DIRECTOR OF NURSING40.0001233119853X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs890061TotalReportableCompFrmRltdOrgs
Total Other Compensation113964TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
LOS NINOS HOSPITAL INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042NURSING REGISTRY AND THERAPY SERVICES389316
HACIENDA INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042MANAGEMENT SERVICES159300
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
All Other Contributions420618AllOtherContributions
Noncash Contributions7567NoncashContributions
Total Contributions420618TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PRIVATE SECTOR REVENUE62300073323577332357
GOVERNMENT REVENUES623000705539705539
FieldValueIRS element (for citing)
Total Program Service Revenue8037896TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column671TotalRevenueColumn
Exclusion$671ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real313231Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real300742Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real12489Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column12489TotalRevenueColumn
Exclusion$12,489ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8471674TotalRevenueColumn
Related Or Exempt Function Income8037896RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$13,160ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4414947Total
Program Services4414947ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total60316Total
Program Services60316ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total361591Total
Program Services361591ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total358524Total
Program Services358524ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total159300Total
Management And General159300ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total11550Total
Management And General11550ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total548533Total
Program Services523263ProgramServices
Management And General25270ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total10314Total
Program Services10314ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total6507Total
Program Services6507ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total262151Total
Program Services262151ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total192648Total
Program Services192648ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total253761Total
Program Services253761ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total202333Total
Program Services202333ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
SUPPLIES332282332282
BAD DEBT EXPENSE152347152347
FOOD144637144637
MEDICAL EQUIPMENT7806578065

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total111410Total
Program Services111410ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total7661216Total
Program Services7465096ProgramServices
Management And General196120ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY700BOY
EOY700EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1160895BOY
EOY1412093EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY72373BOY
EOY24255EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1196784BOY
EOY1027835EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY26186BOY
EOY4355EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY13227BOY
EOY2416EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis11326923LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1622432LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY10043451BOY
EOY9704491EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1113300BOY
EOY1331696EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY13626916BOY
EOY13507841EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY814372BOY
EOY260312EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY6000000BOY
EOY6000000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3104515BOY
EOY2502945EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9918887BOY
EOY8763257EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3636823BOY
EOY4317502EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY71206BOY
EOY427082EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3708029BOY
EOY4744584EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY13626916BOY
EOY13507841EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses810458ReconcilationRevenueExpenses
Reconcilation Other Changes226097ReconcilationOtherChanges
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 Years278143CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years59509CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years520732CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year204464CurrentTaxYearMinus1Year
Current Tax Year420618CurrentTaxYear
Total1483466Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4335915CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6833526CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7060007CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7598206CurrentTaxYearMinus1Year
Current Tax Year8037896CurrentTaxYear
Total33865550Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4614058CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6893035CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7580739CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7802670CurrentTaxYearMinus1Year
Current Tax Year8458514CurrentTaxYear
Total35349016Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years37224CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years300000CurrentTaxYearMinus2Years
Current Tax Year265600CurrentTaxYear
Total602824Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years37224CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years300000CurrentTaxYearMinus2Years
Current Tax Year265600CurrentTaxYear
Total602824Total
FieldValueIRS element (for citing)
Public Support Total50934746192PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7893CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8843CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3213CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2003CurrentTaxYearMinus1Year
Current Tax Year671CurrentTaxYear
Total22623Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7893CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8843CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3213CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2003CurrentTaxYearMinus1Year
Current Tax Year671CurrentTaxYear
Total22623Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8366CurrentTaxYearMinus4Years
Total8366Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4630317CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6901878CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7583952CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7804673CurrentTaxYearMinus1Year
Current Tax Year8459185CurrentTaxYear
Total35380005Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98210PublicSupportPercentage509
Prior Year Support Percentage0.98220PriorYearSupportPercentage
Investment Income Percentage0.00060InvestmentIncomePercentage
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 D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10180219OtherCostOrOtherBasis
Depreciation1081748Depreciation
Book Value9098471BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis87006OtherCostOrOtherBasis
Depreciation17963Depreciation
Book Value69043BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1059698OtherCostOrOtherBasis
Depreciation522721Depreciation
Book Value536977BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings9704491TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM RELATED AFFILIATE1320829
SCHOOL LOANS RECEIVABLE10867
FieldValueIRS element (for citing)
Total Book Value Other Assets1331696TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO RELATED AFFILIATE$2,240,168
INTEREST RATE SWAP AGREEMENT$262,777
FieldValueIRS element (for citing)
Total Of Amounts2502945TotalOfAmounts
Total Revenue8471674TotalRevenue
Total Expenses7661216TotalExpenses
Excess Or Deficit For Year810458ExcessOrDeficitForYear
Other$226,097OtherAmount
Total Adjustments226097TotalAdjustments
Excess Or Deficit Per FS1036555ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt8998513TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal8998513RevenueSubtotal
Other Revenues Not Included-526839OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-526839RevenueNotRptdOnFinStmt
Total Revenue Per Form9908471674TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt7961958TotExpensesEtcAuditedFinclStmt
Other Expenses Included300742OtherExpensesIncluded
Expenses Not Rptd F990300742ExpensesNotRptdF990
Expenses Subtotal7661216ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9907661216TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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.
PART XI, LINE 8 - OTHER ADJUSTMENTS:GAIN ON INTEREST RATE SWAP AGREEMENT 226,097.
PART XII, LINE 4B - OTHER ADJUSTMENTS:INTEREST EXPENSE NETTED WITH RENTAL INCOME ON FORM 990 -115,648. DEPRECIATION EXPENSE NETTED WITH RENTAL INCOME ON FORM 990 -185,094. GAIN ON INTEREST RATE SWAP AGREEMENT -226,097.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:INTEREST EXPENSE NETTED WITH RENTAL INCOME ON FORM 990 115,648. DEPRECIATION EXPENSE NETTED WITH RENTAL INCOME ON FORM 990 185,094.

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
0346827000002200008244037707100
DALE SKURDAHL
01957610000021205021525023849100

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationCERTAIN EMPLOYEES PARTICIPATED IN A SECTION 457B PLAN. THE AMOUNTS LISTED BELOW ARE THE EMPLOYEE CONTRIBUTIONS TO THIS PLAN IN CALENDAR YEAR 2011. WILLIAM TIMMONS - $22,000 DALE SKURDAHL - $22,000 JANET LOVELADY - $ 1,350Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE 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 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 MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII, LINE 1AHACIENDA SKILLED NURSING FACILITY, INC. IS RELATED TO TWO TAX EXEMPT AFFILIATES, HACIENDA, INC. AND LOS NINOS HOSPITAL, 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.COMPENSATION FROM RELATED ORGANIZATION
FORM 990, PART XI, LINE 5:GAIN ON INTEREST RATE SWAP AGREEMENT 226,097. TOTAL TO FORM 990, PART XI, LINE 5: 226,097.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2CTHE ORGANIZATION'S BOARD OF DIRECTORS, CEO, AND FINANCE DIRECTOR ARE RESPONSIBLE FOR THE OVERSIGHT OF THE FINANCIAL STATEMENTS AND THE AUDIT OF THE FINANCIAL STATEMENTS.

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 ORGAIZATIONSAZ501(C)(3)LINE 9N/A0
HACIENDA INC
1402 E SOUTH MOUNTAIN AVEPHOENIXAZ85042860253158NURSING 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 Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
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 Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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