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 860253158 HACIENDA INC HACI 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 17593979 0 X www.haciendahealthcare.org X 1970 AZ PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 12 12 414 0 70664 -20054 452387 256374 15149597 14574467 145879 182117 871653 980910 16619516 15993868 0 0 12301821 13253351 0 0 4102758 4071223 16404579 17324574 214937 -1330706 6594909 12438044 6004178 12995267 590731 -557223 PROVIDE SERVICES FOR HANDICAPPED AND CHRONICALLY ILL CHILDREN 0 0 10961649 11518805 Intermediate Care Facility - PROVIDES MEDICAL, EDUCATIONAL, SOCIAL, AND RECREATIONAL NEEDS TO THOSE WHO ARE DISABLED. 308713 305684 DAY TREATMENT AND TRAINING - A PROGRAM FOR YOUNG ADULTS AND TEENAGERS WITH DEVELOPMENTAL DISABILITIES. 3192050 3282904 GROUP HOMES AND MEDICAL GROUP HOMES - PROVIDES AROUND-THE- CLOCK SUPERVISION TO CHRONICALLY ILL CHILDREN WHO DO NOT REQUIRE ON SITE DOCTORS, NURSES, AND THERAPISTS. 356365 377320 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. 356365 377320 14818777 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 19 0 414 1 1 1 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 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 360868 0 21188 Dale Skurdahl 50.00 X 220240 0 38679 Robert Miller 50.00 X 149760 0 7596 Jim Smith 50.00 X 0 0 0 RICHARD HART 40.00 X 35432 0 0 Staci Glass 50.00 X 130753 0 32694 Joseph O'Malley 50.00 X 121388 0 12935 Janet Lovelady 50.00 X 117582 0 21330 Anne Crisler 50.00 X 114576 0 12428 Lysa Garcia 50.00 X 115786 0 6469 1366385 0 153319 8 0 1 0 Hacienda Skilled Nursing Facility Inc 1402 E South Mountain Ave Phoenix AZ 85042 Rent 300233 1 256374 51816 256374 GOVERNMENT FEES FOR SE 623000 14297886 14297886 PRIVATE SECTOR FEES FO 623000 276581 276581 14574467 109176 109176 1673052 1600111 72941 72941 72941 MANAGEMENT FEES 623000 885307 885307 Catering income 623000 70664 70664 Miscellaneous income 623000 24939 24939 980910 15993868 15484713 70664 182117 730868 370000 360868 10414473 8586487 1827986 260375 242149 18226 1076218 1005233 70985 771417 717418 53999 44411 34245 10166 24201 24201 188878 188878 44566 37828 6738 63105 49277 13828 675044 663910 11134 4134 3768 366 279540 273878 5662 417425 399906 17519 Supplies 1335693 1318177 17516 Food 359709 359709 Equipment expense 252368 222191 30177 Other operating expense 200538 178006 22532 Fleet expenses 101655 101655 79956 66062 13894 17324574 14818777 2505797 0 18516 3160 1344191 1262022 152969 175197 227275 233812 5626187 3133156 2364208 2493031 2337363 8197646 150387 73176 6594909 12438044 1198039 1020608 128764 223319 4677375 11751340 6004178 12995267 X 373943 -738037 213588 177614 3200 3200 590731 -557223 6594909 12438044 X 0 1 1 X 0 X 67080 487255 199002 452287 256374 1461998 9542487 11826723 13675375 15149597 14574467 64768649 9609567 12313978 13874377 15601884 14830841 66230647 0 0 0 66230647 43842 78156 144505 145879 182117 594499 43842 78156 144505 145879 182117 594499 -1203 -20054 -21257 529458 798515 809104 871653 885307 3894037 10182867 13190649 14827986 16618213 15878211 70697926 0.93680 0.93860 0.00840 0.00850 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 34000 34000 2591787 1245632 1346155 1145778 542668 603110 1180977 877286 303691 673645 467570 206075 2493031 DUE TO RELATED AFFILIATE 11600083 Line of Credit 151257 11751340 15993868 17324574 -1330706 182752 182752 -1147954 16176620 182752 182752 15993868 0 15993868 17324574 0 17324574 0 17324574 Part X: Description of Uncertain Tax Positions Under FIN 48: Effective January 1, 2009, the Organization follows Accounting Standards for uncertainty in income taxes, which require that tax positions initially need to be recognized 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. X 0 0 0 0 0 0 0 0 0 William Timmons 310868 0 50000 0 0 0 13719 0 7469 0 382056 0 0 0 Dale Skurdahl 203377 0 16863 0 0 0 11437 0 27242 0 258919 0 0 0 Robert Miller 127794 0 21966 0 0 0 6589 0 1007 0 157356 0 0 0 Staci Glass 107594 0 23159 0 0 0 6116 0 26578 0 163447 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) 4 officers of SMHS are board members of organization 1280301 The Organization purchases health care supplies from SMHS 0 South Mountain Health Supply Inc (SMHS) 4 officers of SMHS are board members of organization 78000 The filing organization provides management services to SMHS. 0 Hacienda Skilled Nursing Facility Inc (SNF) same board of directors 159300 The filing organization provides management services to SNF. 0 Los Ninos Hospital Inc (LNH) same board of directors 636000 The filing organization provides management services to LNH. 0 Los Ninos Hospital Inc (LNH) same board of directors 38465 LNH provides nursing registry services and therapy services to the filing organization 0 hacienda Skilled Nursing Facility Inc (SNF) same board of directors 300233 SNF charges rent to the filing organization for use of its facility. 0 X Playing cards 1 20122 FMV X Landscape 1 5230 X Miscellaneous kids supplies 10 26464 0 0 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 UPON REQUEST. 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 LOS NINOS HOSPITAL, INC. (LNH)(A TAX EXEMPT ENTITY); HACIENDA SKILLED NURSING FACILITY, INC. (SNF) (A TAX EXEMPT ENTITY); CHILDREN'S ANGEL FOUNDATION (A TAX EXEMPT ENTITY); AND SOUTH MOUNTAIN HEALTH SUPPLY, INC. (SMHS)(A TAXABLE ENTITY). SMHS 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. SNF, LNH, SMHS, AND CAF ALL PAY MANAGEMENT FEES TO THE FILING ORGANIZATION FOR AN ALLOCATED PORTION OF THESE SERVICES AS WELL AS FOR OTHER SHARED SERVICES. 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 9 LOS NINOS HOSPITAL INC 1402 E SOUTH MOUNTAIN AVE PHOENIX AZ 85042 860892673 NON-PROFIT CHILDREN'S HOSPITAL AZ 3 9 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 0 0 1 1 0 1 0 0 1 1 1 1 1 0 0 0 0