DOMINICAN OAKS CORPORATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- DOMINICAN OAKS CORPORATION (EIN 77-0127719)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-03
- IRS object ID
- 201111239349301166
- Schema version
- 2009v1.7
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-03T15:34:06-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 SECOND STREET SUITE 1400 | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770127719 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dominican Oaks Corporation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DOMI | NameControl |
| Phone | 8314626257 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1555 Soquel Drive | AddressLine1 |
| City | Santa Cruz | City |
| State | CA | State |
| ZIP Code | 95065 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL WALSH | Name |
| Title | CFO | Title |
| Date Signed | 2011-04-20 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4159635100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL WALSH CFO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1555 SOQUEL DRIVE | AddressLine1 |
| City | SANTA CRUZ | City |
| State | CA | State |
| ZIP Code | 95065 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 16390821 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.chwhealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | To operate and manage a 206 unit housing complex for low to moderate income elderly persons. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 101 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 400 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 6361856 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 9478408 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9857250 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 72247 | InvestmentIncomePriorYear |
| Investment Income Current Year | 14819 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 173350 | OtherRevenuePriorYear |
| Other Revenue Current Year | 156896 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 9724405 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16390821 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4050389 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4319468 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7405887 | OtherExpensePriorYear |
| Other Expenses Current Year | 4634949 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 11456276 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8954417 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1731871 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 7436404 | RevenuesLessExpensesCY |
| Total Assets BOY | 10629535 | TotalAssetsBOY |
| Total Assets EOY | 17045408 | TotalAssetsEOY |
| Total Liabilities BOY | 11379439 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10358908 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -749904 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6686500 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO DEVELOP, CONSTRUCT, ESTABLISH, EQUIP, MAINTAIN, OWN AND OPERATE HOUSING FOR AGING LOW AND MODERATE INCOME PERSONS AND FAMILIES. TO PROVIDE AND ENGAGE IN SUCH OTHER ACTIVITIES, INCLUDING WITHOUT LIMITATION, THE PROVISION OF NONPROFIT HOUSING FOR AGING IN A FINANCIALLY SECURE ENVIRONMENT; THE ARRANGEMENT FOR HEALTH CARE, PERSONAL CARE AND SPECIAL SERVICES FOR THE AGING; AND EDUCATIONAL, SCIENTIFIC AND RESEARCH ACTIVITIES RELATED TO THE CARE OF THE AGING, AS MAY BE DEEMED ADVISABLE, ALL IN FURTHERANCE OF THIS CORPORATION'S CHARITABLE PURPOSES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 6527619 | Expense |
| Grants | 0 | Grants |
| Revenue | 9318772 | Revenue |
| Description | CONGREGATE LIVING SERVICES TO ALL RESIDENTS. INCLUDES THREE MEALS A DAY, HOUSEKEEPING, LAUNDRY SERVICE, UTILITIES, SCHEDULED TRANSPORTATION, SECURITY AND EXERCISE ROOM. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 805790 | Expense |
| Grants | 0 | Grants |
| Revenue | 682174 | Revenue |
| Description | ASSISTED LIVING SERVICES TO A PORTION OF RESIDENTS. INCLUDES CAREGIVERS AVAILABLE TO RESIDENTS 24HRS/DAY. CAREGIVERS PROVIDE BATHING, DRESSING, GROOMING, MEDICATION MANAGEMENT, AND LIGHT HOUSEKEEPING. ALSO INCLUDED IS AN RN CASE MANAGER WHO IS ON SITE M-F AND ON-CALL 24/7. THERE'S A SEPARATE ACTIVITIES PROGRAM OFFERED FOR THE ASSISTED LIVING RESIDENTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 7333409 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 101 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | GREG SIMS FINANCE DEPT | NamePerson |
| Telephone Number | 8314627637 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1555 SOQUEL DRIVE | AddressLine1 |
| City | SANTA CRUZ | City |
| State | CA | State |
| ZIP Code | 95065 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| Sally Boyd | ||||||||
| Board Member/Dir of Congregate | 40.0 | X | 127317 | 0 | 13589 | |||
| Eric Johnson | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| DR Nanette Mickiewicz | ||||||||
| PRESIDENT/Service Area Leader | 1.0 | X | 0 | 576528 | 68642 | X | ||
| Gilbert Paul | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| William G Potter | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Jack Baskin | ||||||||
| Chair | 1.0 | X | 0 | 0 | 0 | X | ||
| Bob Ridino | ||||||||
| Vice Chair | 1.0 | X | 0 | 0 | 0 | X | ||
| Mari Tustin | ||||||||
| Secretary | 1.0 | X | 0 | 0 | 0 | X | ||
| Michael Walsh | ||||||||
| CFO/Treasurer | 1.0 | X | 0 | 94299 | 7336 | X | ||
| Dave Bingham | ||||||||
| Facilities Director | 40.0 | 101670 | 0 | 15619 | X | |||
| Deborah L Routley | ||||||||
| Supervisor Comm Relations | 40.0 | 112659 | 0 | 23757 | X | |||
| David Herman | ||||||||
| Former CFO | 0 | 183666 | 34130 | X | ||||
| Rick Harron | ||||||||
| Former CFO | 0 | 273466 | 3552 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 341646 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1127959 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 166625 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BOGARD CONSTRUCTION INC | |||||
| 350-A CORAL ST | SANTA CRUZ | CA | 95060 | General Contractor | 2194726 |
| FIRST ALARM | |||||
| 1111 ESTATES DR 5 | APTOS | CA | 95003 | Security Services | 165042 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Related Organizations | 6361856 | RelatedOrganizations |
| Total Contributions | 6361856 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ASSISTED LIVING REVENUE | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 9857250 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9857250 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9857250 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14819 | TotalRevenueColumn |
| Exclusion | $14,819 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 13200 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 13200 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13200 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $13,200 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| CAFETERIA | 900099 | 33647 | 33647 |
| PARKING LOT | 812930 | 6976 | 6976 |
| GIFT SHOPS | 453220 | 522 | 522 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 102551 | TotalRevenueColumn |
| Related Or Exempt Function Income | 102551 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 143696 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16390821 | TotalRevenueColumn |
| Related Or Exempt Function Income | 10000946 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $28,019 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 135633 | Total |
| Program Services | 118152 | ProgramServices |
| Management And General | 17481 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2999115 | Total |
| Program Services | 2612581 | ProgramServices |
| Management And General | 386534 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27558 | Total |
| Program Services | 24006 | ProgramServices |
| Management And General | 3552 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 904476 | Total |
| Program Services | 787905 | ProgramServices |
| Management And General | 116571 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 252686 | Total |
| Program Services | 220119 | ProgramServices |
| Management And General | 32567 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 280 | Total |
| Management And General | 280 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3200 | Total |
| Management And General | 3200 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 504 | Total |
| Management And General | 504 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1793596 | Total |
| Program Services | 961809 | ProgramServices |
| Management And General | 831787 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47397 | Total |
| Management And General | 47397 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 315087 | Total |
| Program Services | 242047 | ProgramServices |
| Management And General | 73040 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 435888 | Total |
| Program Services | 435888 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2778 | Total |
| Program Services | 434 | ProgramServices |
| Management And General | 2344 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11279 | Total |
| Program Services | 1772 | ProgramServices |
| Management And General | 9507 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 637861 | Total |
| Program Services | 633332 | ProgramServices |
| Management And General | 4529 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 564851 | Total |
| Program Services | 560841 | ProgramServices |
| Management And General | 4010 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69120 | Total |
| Management And General | 69120 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| LICENSES & TAXES | 176688 | 176688 | ||
| DUES & SUBSCRIPTIONS | 15156 | 15156 | ||
| MEDICAL SUPPLIES | 3774 | 3774 | ||
| RECRUITING | 3429 | 3429 | ||
| FOOD SUPPLIES | 554061 | 554061 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8954417 | Total |
| Program Services | 7333409 | ProgramServices |
| Management And General | 1621008 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 900 | BOY |
| EOY | 900 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2027158 | BOY |
| EOY | 8982352 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2992 | BOY |
| EOY | 3950 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13021 | BOY |
| EOY | 19189 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 20634849 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 12595832 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8585464 | BOY |
| EOY | 8039017 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10629535 | BOY |
| EOY | 17045408 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 844944 | BOY |
| EOY | 571954 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51700 | BOY |
| EOY | 56800 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10482795 | BOY |
| EOY | 9730154 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11379439 | BOY |
| EOY | 10358908 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -749904 | BOY |
| EOY | 6686500 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -749904 | BOY |
| EOY | 6686500 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10629535 | BOY |
| EOY | 17045408 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 101045 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 400 | CurrentTaxYearMinus1Year |
| Current Tax Year | 6361856 | CurrentTaxYear |
| Total | 6463301 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 7928368 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8489776 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 8984243 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9484611 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9857250 | CurrentTaxYear |
| Total | 44744248 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 7928368 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8590821 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 8984243 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9485011 | CurrentTaxYearMinus1Year |
| Current Tax Year | 16219106 | CurrentTaxYear |
| Total | 51207549 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 51207549 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 117593 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 188457 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 191894 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 84591 | CurrentTaxYearMinus1Year |
| Current Tax Year | 28019 | CurrentTaxYear |
| Total | 610554 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 117593 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 188457 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 191894 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 84591 | CurrentTaxYearMinus1Year |
| Current Tax Year | 28019 | CurrentTaxYear |
| Total | 610554 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 173081 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 141597 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 161396 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 160450 | CurrentTaxYearMinus1Year |
| Current Tax Year | 143696 | CurrentTaxYear |
| Total | 780220 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8219042 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8920875 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9337533 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9730052 | CurrentTaxYearMinus1Year |
| Current Tax Year | 16390821 | CurrentTaxYear |
| Total | 52598323 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.97356 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.96979 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.01161 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.01434 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
| General Explanation | THIS IS INCOME GENERATED FROM CAFETERIA, PARKING LOT, COMMUNITY FEES, GIFT SHOPS AND OTHER REVENUE. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $504 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 504 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1593403 | OtherCostOrOtherBasis |
| Book Value | 1593403 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11115035 | OtherCostOrOtherBasis |
| Depreciation | 5359733 | Depreciation |
| Book Value | 5755302 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7580527 | OtherCostOrOtherBasis |
| Depreciation | 6904699 | Depreciation |
| Book Value | 675828 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 345884 | OtherCostOrOtherBasis |
| Depreciation | 331400 | Depreciation |
| Book Value | 14484 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8039017 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO RELATED PARTIES | $9,172,089 |
| SECURED MORTGAGES & NOTES PAYA | $558,065 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 9730154 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, PART X, LINE 25 | Identifier |
| Explanation | The consolidated audited financial statements did not include a FIN 48 footnote disclosure as the liability was determined not material for reporting purposes. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR Nanette Mickiewicz | |||||||||||||
| 0 | 345175 | 0 | 208960 | 0 | 22393 | 0 | 36294 | 0 | 32348 | 0 | 645170 | 0 | 0 |
| David Herman | |||||||||||||
| 0 | 157099 | 0 | 26360 | 0 | 207 | 0 | 15083 | 0 | 19047 | 0 | 217796 | 0 | 0 |
| Rick Harron | |||||||||||||
| 0 | 9268 | 0 | 0 | 0 | 264198 | 0 | 1837 | 0 | 1715 | 0 | 277018 | 0 | 93471 |
Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| FORM 990, PART VII, SECTION A & B | The organization's employees and contractors W-2 and 1099's are filed by the related organization, Catholic Healthcare West dba Dominican Hospital. |
| PART I, LINE3 | The Organization relied on a related organization, Catholic Healthcare West, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the organization's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, line 15 for additional information. |
| Part I, Line 4a | The organization's key employees and certain officers and highly compensated employees participate in a severance plan that provides fair compensation, ranging from payments of 6 months to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. Payments pursuant to the plan arrangement for one former officer occurred during 2009; R. Harron $141,326. |
| Part I, Line 4b | Certain listed persons hired prior to June 30, 2006 are eligible to participate in the CHW Executive Deferred Compensation Plan, a nonqualified 457(f) plan which is intended to provide a benefit approximating the difference, if any, between the benefit provided under the CHW Excess Benefit Plan and the benefit provided under the qualified benefit plan that substantially replaced the Excess Plan. No benefit will vest under the 457(f) plan before the later of the attainment of age 62 while employed or the completion of 15 years of service. Certain listed persons participate in the CHW Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the CHW Retirement Plan whose benefits are affected by the limitations imposed by sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. A payment of $93,471 was made to R. Harron during 2009. |
| Part II - Supplemental Disclosures | Although the organization employs personnel, the supported organization's executive compensation philosophy is designed to assist in attracting and retaining the caliber of executives required to fulfill the organization's mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities the organization serves, promoting employee satisfaction, and ensuring financial stability. A substantial portion of executive compensation is performance based and is linked to organizational goals approved in advance by the Compensation and Benefits Committee. These goals include attainment of annual and long-term financial performance, certain healthcare quality standards and the organization's commitment to serving the poor and disenfranchised in the communities it serves. MR HERMAN, A FORMER CFO, IS COMPENSATED AS AN EMPLOYEE OF THE RELATED ORGANIZATION. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE | FORM 990, PART VI, SECTION A, LINE 6 The organization has a sole corporate member, Dominican Health Services, a 501(c)(3), exempt organization, and Catholic Healthcare West, a 501(c)(3) exempt organization, is the sole corporate member of Dominican Health Services. FORM 990, PART VI, SECTION A, LINE 7a Dominican Health Services (DHS), as the sole corporate member, ratifies the selection of members and the corporation's Board of Directors approves new Board members of the organization. FORM 990, PART VI, SECTION A, LINE 7b Reserved rights of the corporate member include adoption of mission and philosophy statements, amendment or restatement of articles of incorporation and bylaws, dissolution of the corporation, acquisition of another corporation, creation of a new subsidiary, merger or consolidation with another corporation, participation as a general or limited partner in any venture, incurring long-term indebtedness in excess of normal operating requirements, ratification of board member appointments and dismissals, selection and removal of independent auditors, and transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11A The Dominican Oaks accounting department worked closely with Catholic Healthcare West (CHW) and AN INDEPENDENT accounting firm ENGAGED TO review the return. The return was also reviewed by the Dominican Oaks CFO before signing it. Due to timing, The Dominican Oaks Board of Directors held a meeting where upon the Dominican Oaks CFO presented the final version of the form 990 to the Board of Directors, subsequent to filing with the Internal Service Revenue. FORM 990, PART VI, SECTION B, LINE 12C The Organization has adopted CHW's Conflicts of Interest Policy. The Organization's Board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the conflicts of interest policy, an annual conflict of interest disclosure statement, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees and all management personnel whose responsibilities include business decisions which may give rise to conflicts of interest). Covered persons are also required to disclose real or potential conflicts at the time such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to submit an updated disclosure statement and to sign a statement affirming that he/she: (1) has received a copy of the conflicts of interest policy; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest disclosure statement. The completed questionnaires are reviewed by CHW's Legal Department and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest related to a proposed transaction include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) if warranted, alternatives to the proposed transaction are investigated, and competitive bids or comparable valuations are obtained; (5) any conflicting issues arising during the course of a board meeting which cannot be resolved are to be referred to an independent committee of the Board of Directors; and (6) the transaction or action must be approved by a majority of disinterested persons. All conflicts of interest, whether resolved or unresolved, are reported in the Organization's Form 990. FORM 990, PART VI, SECTION B, LINE 15a Although the organization employs personnel, the Service Area Leader is compensated by Catholic Healthcare West (CHW). FOR 2009, CHW's Compensation and Benefits department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the Service Area Leader. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) WAS obtained from independent third-party survey sources. FORM 990, PART VI, SECTION B, LINE 15b Other officers or key employees' compensation is determined using competitive rates from other assisted living communities, as well as comparable health care facilities. Yearly increases in salary are calculated based on increased cost of living. FORM 990, PART VI, SECTION B, LINE 19 Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its financial statements available on its website and upon request. |
| PART I, LINE 5 and PART V, LINE 2a | THE ORGANIZATION'S EMPLOYEES AND CONTRACTORS W-2's and 1099's are filed by the related organization, Catholic Healthcare West dba Dominican Hospital. |
| FORM 990, PART VII, SECTION A | The following individuals listed on Form 990 Part VII were compensated by Catholic Healthcare West, the supported organization. An estimate of their hours provided to the supported organization is provided: Dr. Nanette Mickiewicz; 40 hours Michael Walsh; 40 hours David Herman; 40 hours |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| Catholic Healthcare West dba Dominican H | |||||||||
| 185 Berry Street | San Francisco | CA | 94107 | 941196203 | Hospital | CA | 501(C)(3) | 3 | NA |
| Dominican Health Services | |||||||||
| 1555 Soquel Drive | Santa Cruz | CA | 95065 | 770056778 | Community Hea | CA | 501(C)(3) | 11 Type I | NA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | None | BusinessNameLine1 |