2012-05-15T10:46:31-05:00 2011-06-30 HENRY & HORNE LLP 7098 E COCHISE SUITE 100 SCOTTSDALE AZ 852534517 990 2010-07-01 860253158 HACIENDA INC HACI 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 WILLIAM TIMMONS 6022434231 2012-05-09 1 COLETTE KAMPS CPA 4804831170 2012-05-09 2010 2016-02-24 21:20:13Z WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85040 16213782 0 X WWW.HACIENDAHEALTHCARE.ORG X 1970 AZ PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 12 12 415 2844 21967 -39534 256374 147380 14574467 15115861 182117 0 980910 950541 15993868 16213782 0 0 0 0 13253351 12426978 0 0 0 4071223 4312113 17324574 16739091 -1330706 -525309 12438044 4720674 12995267 6168075 -557223 -1447401 X PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 0 0 10646095 12082443 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. 315933 348086 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. 3272222 3312900 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. 310820 301006 DAY TREATMENT AND TRAINING - A PROGRAM FOR YOUNG ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. 310820 301006 14545070 1 1 0 1 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 0 0 0 0 0 1 0 0 0 0 1 20 0 415 1 1 1 0 0 0 0 0 0 0 X 12 12 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 CARL MUNDING 1.00 X 0 0 0 THOM NIEMIEC 1.00 X 0 0 0 GARY ORMAN 1.00 X 0 0 0 RALPH WALLWORK 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 MICHAEL STONE 2.00 X X 0 0 0 PETER RANKE 2.00 X X 0 0 0 BARRY GOLDSTIN 2.00 X X 0 0 0 WILLIAM TIMMONS 40.00 X 378315 0 22964 DALE SKURDAHL 40.00 X 193366 0 41354 JAMES SMITH 40.00 X 161691 0 14379 ROBERT MILLER 40.00 X 137009 0 7989 STACI GLASS 40.00 X 142085 0 36590 JOSEPH O'MALLEY 40.00 X 116029 0 15719 MELINDA MORALES 40.00 X 110161 0 11300 JANET LOVELADY 40.00 X 110126 0 7086 ANN CRISLER 40.00 X 109276 0 13527 1458058 0 170908 9 0 1 0 HACIENDA SKILLED NURSING FACILITY INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85040 RENT 300237 1 34968 112412 24430 147380 GOVERNMENT REVENUE 623990 14809593 14809593 PRIVATE SECTOR REVENUE 623990 306268 306268 15115861 MANAGEMENT FEES 623990 888998 888998 MEALS AND MISCELLANEOU 623990 39576 39576 CATERING INCOME 623990 21967 21967 950541 16213782 16044435 21967 0 909505 909505 9401066 8430694 970372 278660 247088 31572 1134994 1134994 702753 569230 133523 114694 92786 21908 251225 225395 25830 46778 40652 6126 43133 35644 7489 665975 660508 5467 13813 11639 2174 287098 283605 3493 458957 443072 15885 SUPPLIES 1446639 1439397 7242 FOOD 339706 339706 EQUIPMENT EXPENSE 239061 214280 24781 OTHER OPERATING EXPENSE 203216 182210 21006 FLEET EXPENSE 110322 110322 91496 83848 7648 16739091 14545070 2194021 0 3160 4960 1262022 1295398 175197 124814 233812 260287 5916303 3406083 2493031 2510220 8197646 452882 73176 72113 12438044 4720674 1020608 1444948 223319 217763 11751340 4505364 12995267 6168075 X -738037 -1516417 177614 65816 3200 3200 -557223 -1447401 12438044 4720674 X -525309 -364869 X 0 1 1 X 0 X 487255 199002 452287 256374 147380 1542298 11826723 13675375 15149597 14574467 16004859 71231021 12313978 13874377 15601884 14830841 16152239 72773319 0 0 0 72773319 78156 144505 145879 182117 550657 -1203 -20054 -39534 -60791 78156 144505 144676 162063 -39534 489866 12392134 14018882 15746560 14992904 16112705 73263185 0.99330 0.93680 0.00670 0.00840 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 95412 95412 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THIRD PARTY LOBBYIST 74000 74000 2742439 1316605 1425834 1230272 621424 608848 1698355 1319408 378947 171237 148646 22591 2510220 DUE TO RELATED AFFILIATE 4056723 DEFERRED COMPENSATION LIABILITY 448641 4505364 16213782 16739091 -525309 -364869 -364869 -890178 16213782 0 16213782 0 16213782 16739091 0 16739091 0 16739091 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, 2011, 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 333315 0 45000 0 0 0 14512 0 8452 0 401279 0 0 0 DALE SKURDAHL 183904 0 9462 0 0 0 10210 0 31144 0 234720 0 0 0 JAMES SMITH 156741 0 4950 0 0 0 0 0 14379 0 176070 0 0 0 STACI GLASS 104918 0 37167 0 0 0 6206 0 30384 0 178675 0 0 0 SOUTH MOUNTAIN HEALTH SUPPLY INC (SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION 1275445 THE FILING ORGANIZATION PURCHASES HEALTH CARE SUPPLIES FROM SMHS. 0 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S CEO, CFO, 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 ADJUSTMENTS: -364,869. 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 1 0 0 0 0 0 1 1 1 1 1 0 1 0 0