2011-05-11T17:15:38-05:00 2010-06-30 Henry & Horne LLP 7098 E Cochise Suite 100 Scottsdale AZ 852534517 990 2009-07-01 860892673 LOS NINOS HOSPITAL INC LOSN 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 WILLIAM TIMMONS 6022434231 2011-05-02 1 Colette Kamps CPA 4804831170 2011-05-02 2009 2016-02-24 21:20:13Z WILLIAM TIMMONS 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 17352891 0 X www.haciendahealthcare.org X 1997 AZ NON-PROFIT CHILDREN'S HOSPITAL 12 12 180 0 0 0 160496 1957 17102257 17295035 91250 53657 2242 17354003 17352891 50000 0 6138446 6533693 0 0 8428668 8579693 14567114 15163386 2786889 2189505 19722985 21918043 1193929 1188593 18529056 20729450 NON-PROFIT CHILDREN'S HOSPITAL 0 0 2777478 2852482 INPATIENT - A 15 BED FAMILY ORIENTED HOSPITAL SPECIALIZING IN HIGH QUALITY ACUTE AND SUB-ACUTE CARE FOR INFANTS, CHILDREN, AND TEENS. 2810956 3810538 HOME HEALTHCARE - PROVIDES HOME HEALTH CARE NEEDS TO INFANTS, CHILDREN, AND YOUNG ADULTS WITH SPECIAL HOME HEALTH CARE NEEDS. 5065749 5695873 OUTPATIENT - HOME TO THE ONLY SYNAGIS OUTPATIENT CLINIC IN ARIZONA PROVIDING IMMUNIZATION AGAINST RESPIRATORY SYNCYTIAL VIRUS. 3794451 4938384 THERAPY SERVICES - PROVIDES A BROAD RANGE OF PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY SERVICCES. SERVICES ARE PROVIDED THROUGH INPATIENT, OUTPATIENT AND HOME HEALTH CARE. THERAPY CLINIC- AN EXTENSION OF THE HOME BASE THERAPY SERVICES PROGRAM.REGISTRY SERVICES - PROVIDES STAFFING NEEDS TO FILL VACANT POSITIONS AND OPEN SHIFTS WITHIN THE PROFESSIONAL SETTING INCLUDING RN'S, LPN'S, CNA'S, CAREGIVERS, AND RESPIRATORY THERAPISTS. VENTILATOR - THIS PROGRAM ENABLES VENTILATOR DEPENDENT INDIVIDUALS TO FUNCTION IN SOCIETY AT THE OPTIMAL LEVEL OF THEIR CAPABILITIES BY COMBINING TECHNOLOGY, SERVICES, AND MEDICAL SUPPLIES. 3794451 4938384 14448634 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 5 0 180 1 0 0 0 0 0 0 0 12 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 AZ X The Organization 6022434231 1402 E SOUTH MOUNTAIN AVENUE PHOENIX AZ 85042 X Carl Munding 5.00 X 0 0 0 Thom Niemiec 5.00 X 0 0 0 Gary Orman 5.00 X 0 0 0 Ralph Wallwork 5.00 X 0 0 0 Patrick Walsh 5.00 X 0 0 0 Bruce Samuels 5.00 X 0 0 0 Wanda O'Malley 5.00 X 0 0 0 Patricia Shaw 5.00 X 0 0 0 Dick Kaupie 5.00 X X 0 0 0 Tom Pomeroy 5.00 X X 0 0 0 Michael Stone 5.00 X X 0 0 0 Peter Ranke 5.00 X X 0 0 0 Barry Goldstin 5.00 X X 0 0 0 William Timmons 50.00 X 0 360868 21188 Dale Skurdahl 50.00 X 0 220240 38679 Robert Miller 50.00 X 0 149760 7596 Jim Smith 50.00 X 0 0 0 RICHARD HART 40.00 X 0 35432 0 Davena Ballard 50.00 X 155190 0 21085 Joseph O'Malley 50.00 X 0 121388 12935 155190 887688 101483 1 0 1 0 Hacienda Inc 1402 E South Mountain Ave Phoenix AZ 85042 management fees 636000 1 1957 1957 1957 PRIVATE SECTOR REVENUE 623000 10362872 10362872 GOVERNMENT REVENUE 623000 5949832 5949832 THERAPY INCOME FROM RE 623000 982331 982331 17295035 53657 53657 miscellaneous 900099 2242 2242 2242 17352891 17297277 0 53657 50000 50000 155190 155190 5392344 5392344 101363 101363 505593 501797 3796 379203 379203 636000 636000 2250 2250 540440 495971 44469 31639 31639 19221 17555 1666 545047 534047 11000 22309 22309 123 123 283514 283514 144309 144309 SUPPLIES 5977933 5962372 15561 EQUIPMENT EXPENSE 187892 187892 MISCELLANEOUS 87980 87970 10 BAD DEBT 69741 69741 FLEET EXPENSES 31295 31295 15163386 14448634 714752 0 5291373 3963827 6138789 50000 1365224 1545158 301257 309976 20230 23188 4675750 2839141 2052463 1836609 107077 117966 6571534 11946357 19722985 21918043 1192400 1133215 1529 55378 1193929 1188593 X 18438344 20722161 90712 7289 18529056 20729450 19722985 21918043 X 0 1 1 X 0 X 77150 47113 5228 160496 1957 291944 13367474 14446794 16118706 17102257 17295035 78330266 13444624 14493907 16123934 17262753 17296992 78622210 0 0 0 78622210 120942 225632 77303 91250 53657 568784 120942 225632 77303 91250 53657 568784 2242 2242 13565566 14719539 16201237 17354003 17352891 79193236 0.99280 0.98470 0.00720 0.00650 X 795024 795024 263146 118569 144577 3338985 2500430 838555 278595 220142 58453 1836609 DUE FROM RELATED AFFILIATES 11934221 EMPLOYEE RECEIVABLES 12136 11946357 CAPITAL LEASE 55378 55378 17352891 15163386 2189505 10889 10889 2200394 17363780 10889 10889 17352891 0 17352891 15163386 0 15163386 0 15163386 Part X: Description of Uncertain Tax Positions Under FIN 48: The Organization recognizes tax positions in the financial statements when it is more likely than not that the positions will not be sustained upon examination by the tax authorities. As of June 30, 2010, the Organization had no uncertain tax positions that qualify for either recognition or disclosure in the financial statements. The Organization's federal and state exempt returns (Form 990 and 99) for fiscal years ended June 30, 2007, 2008, 2009 and 2010 are subject to examination by the IRS and the State of Arizona, generally for three years after they were filed. 1 1 1 X 1 X 1 0 0 0 2552 0 2552 0.00000 270274 0 270274 0.01800 0 0 0.00000 272826 272826 0.01800 272826 272826 0.01800 1 69741 0 152539 123967 28572 X 1 1 LOS NINOS HOSPITAL INC

2303 E THOMAS RD PHOENIX AZ 85016

X X 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 DUE TO THE NATURE OF THEIR MEDICAL CONDITIONS, 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 SUB-ACUTE HOSPITAL CARE TO INFANTS AND CHILDREN LESS EXPENSIVELY THAN LARGER ACUTE 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 RESPIRATORY SYNCYTIAL VIRUS, THEREBY SAVING LIVES AND MINIMIZING THE POTENTIAL FOR EXPENSIVE LIFELONG RESPIRATORY TREATMENT. LOS NINOS HOSPITAL'S HOME VENTILATOR PROGRAM AND HOME HEALTH SERVICES PROVIDE PATIENTS WITH EFFECTIVE HEALTH CARE IN THEIR HOMES, A FAR LESS EXPENSIVE SETTING THAN HOSPITALS, THEREBY FURTHER SAVING INCREASINGLY SCARCE GOVERNMENT FUNDS. 1 HACIENDA SKILLED NURSING FACILITY INC 1402 EAST SOUTH MOUNTAIN AVENUE phoenix AZ 85042 141906233 3 50000 Capital campaign 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The contribution given during fiscal year 2010 was to an affiliated organization, as determined by the board of directors. X 0 0 0 0 0 0 0 0 0 William Timmons 0 310868 0 50000 0 0 0 13719 0 7469 0 382056 0 0 Dale Skurdahl 0 203377 0 16863 0 0 0 11437 0 27242 0 258919 0 0 Robert Miller 0 127794 0 21966 0 0 0 6589 0 1007 0 157356 0 0 Davena Ballard 137407 0 17783 0 0 0 5331 0 15754 0 176275 0 0 0 Pomeroy & Pomeroy Entity more than 35% owned by T.Pomeroy, board member 0 Insurance Brokerage services 0 South Mountain Health Supply Inc (SMHS) OFFICERS OF SMHS ARE BOARD MEMBERS OF FILING ORGANIZATION 5562352 The organization purchases health care supplies from SMHS. 0 Hacienda Inc same board of directors 636000 Hacienda provides management services to the filing organization. 0 Hacienda Inc Same board of directors 38465 The filing organization provides nurse registry services and therapy services to Hacienda. 0 Hacienda Skilled Nursing Facility Inc (SNF) same board of directors 897516 The filing organization provides nurse registry services and therapy services to SNF. 0 Hacienda Skilled Nursing Facility Inc (SNF) same board of directors 11423 SNF charges rent to the filing organization for use of its facility. 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 officers and KEY EMPLOYEES OF THE ORGANIZATION. Form 990, Part VI, Section C, line 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, and FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. SCHEDULE R- PART II AND PART IV THE FILING ORGANIZATION IS PART OF A GROUP OF ENTITIES WHICH ARE ALL AFFILIATED UNDER THE NAME HACIENDA HEALTHCARE. THIS GROUP OF ENTITIES ALSO INCLUDES HACIENDA SKILLED NURSING FACILITY, INC.(SNF)(A TAX EXEMPT ENTITY); HACIENDA, INC. (HACIENDA) (A TAX EXEMPT ENTITY); CHILDREN'S ANGEL FOUNDATION (A TAX EXEMPT ENTITY); AND SOUTH MOUNTAIN HEALTH SUPPLY, INC. (SMHS)(A TAXABLE ENTITY). SOUTH MOUNTAIN HEALTH SUPPLY is WHOLLY OWNED BY HACIENDA HEALTHCARE AND FILEs AS a SEPARATE TAXABLE ENTITY. HACIENDA EMPLOYS THE FOUR EMPLOYEES WHO SERVE AS THE TOP MANAGEMENT OFFICIALS OF ALL OF THESE ENTITIES. THE FILING ORGANIZATION, SNF, SMHS, AND CAF ALL PAY MANAGEMENT FEES TO HACIENDA FOR AN ALLOCATED PORTION OF THESE SERVICES AS WELL AS FOR OTHER SHARED SERVICES. THE SALARIES LISTED FOR THESE INDIVIDUALS ON PART 7 REPRESENT 100% OF THEIR SALARIES PER THEIR FORMS W-2. HACIENDA HEALTHCARE INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 272988610 BRAND NAME FOR RELATED ORGANIZATIONS AZ 3 7 HACIENDA SKILLED NURSING FACILITY INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 141906233 NURSING CARE & RESPIRATORY INTERVENTION AZ 3 7 HACIENDA Inc 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860253158 PROVIDE SERVICES FOR HANDICAPPED & CHRONICALLY ILL CHILDREN AZ 3 7 SOUTH MOUNTAIN HEALTH SUPPLY 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860858893 MEDICAL SUPPLY COMPANY AZ HACIENDA HEALTHCARE INC C INNOVATIVE HOME HEALTH INC 1402 E SOUTH MOUNTAIN AVE pHOENIX AZ 85042 262398755 HOME HEALTH NURSING SERVICES AZ HACIENDA HEALTHCARE INC C 0 1 0 1 0 0 1 0 0 1 1 1 1 1 0 0 0 0