2011-05-03T15:34:06-05:00 2010-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2009-07-01 770127719 Dominican Oaks Corporation DOMI 8314626257 1555 Soquel Drive Santa Cruz CA 95065 MICHAEL WALSH 2011-04-20 4159635100 2009 2016-02-24 21:20:13Z MICHAEL WALSH CFO 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 16390821 false X www.chwhealth.org X 1986 CA To operate and manage a 206 unit housing complex for low to moderate income elderly persons. 8 5 101 0 0 0 400 6361856 9478408 9857250 72247 14819 173350 156896 9724405 16390821 0 0 0 0 4050389 4319468 0 0 0 7405887 4634949 11456276 8954417 -1731871 7436404 10629535 17045408 11379439 10358908 -749904 6686500 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. false false 6527619 0 9318772 CONGREGATE LIVING SERVICES TO ALL RESIDENTS. INCLUDES THREE MEALS A DAY, HOUSEKEEPING, LAUNDRY SERVICE, UTILITIES, SCHEDULED TRANSPORTATION, SECURITY AND EXERCISE ROOM. 805790 0 682174 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. 7333409 true true false true false false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 11 0 true 101 true false false false false false false false false false 8 5 false false false false true true true true true false false false true true true true true false false false CA X GREG SIMS FINANCE DEPT 8314627637 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 Sally Boyd 40.0 X 127317 0 13589 Eric Johnson 1.0 X 0 0 0 DR Nanette Mickiewicz 1.0 X X 0 576528 68642 Gilbert Paul 1.0 X 0 0 0 William G Potter 1.0 X 0 0 0 Jack Baskin 1.0 X X 0 0 0 Bob Ridino 1.0 X X 0 0 0 Mari Tustin 1.0 X X 0 0 0 Michael Walsh 1.0 X X 0 94299 7336 Dave Bingham 40.0 X 101670 0 15619 Deborah L Routley 40.0 X 112659 0 23757 David Herman X 0 183666 34130 Rick Harron X 0 273466 3552 341646 1127959 166625 3 true true false 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 2 6361856 6361856 ASSISTED LIVING REVENUE 623000 9857250 9857250 9857250 14819 14819 0 0 13200 0 13200 13200 0 0 13200 0 0 0 0 CAFETERIA 900099 33647 33647 PARKING LOT 812930 6976 6976 GIFT SHOPS 453220 522 522 102551 102551 143696 16390821 10000946 0 28019 0 0 0 0 135633 118152 17481 0 2999115 2612581 386534 27558 24006 3552 904476 787905 116571 252686 220119 32567 0 280 280 3200 3200 504 504 0 0 1793596 961809 831787 47397 47397 315087 242047 73040 0 0 435888 435888 2778 434 2344 0 11279 1772 9507 637861 633332 4529 0 564851 560841 4010 69120 69120 LICENSES & TAXES 176688 176688 DUES & SUBSCRIPTIONS 15156 15156 MEDICAL SUPPLIES 3774 3774 RECRUITING 3429 3429 FOOD SUPPLIES 554061 554061 0 8954417 7333409 1621008 0 900 900 2027158 8982352 2992 3950 13021 19189 20634849 12595832 8585464 8039017 10629535 17045408 844944 571954 51700 56800 10482795 9730154 11379439 10358908 X -749904 6686500 -749904 6686500 10629535 17045408 X false true true X false X 0 101045 0 400 6361856 6463301 7928368 8489776 8984243 9484611 9857250 44744248 7928368 8590821 8984243 9485011 16219106 51207549 51207549 117593 188457 191894 84591 28019 610554 117593 188457 191894 84591 28019 610554 173081 141597 161396 160450 143696 780220 8219042 8920875 9337533 9730052 16390821 52598323 0.97356 0.96979 0.01161 0.01434 X THIS IS INCOME GENERATED FROM CAFETERIA, PARKING LOT, COMMUNITY FEES, GIFT SHOPS AND OTHER REVENUE. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 504 false false false 504 false 1593403 1593403 11115035 5359733 5755302 7580527 6904699 675828 345884 331400 14484 8039017 0 DUE TO RELATED PARTIES 9172089 SECURED MORTGAGES & NOTES PAYA 558065 9730154 FORM 990, PART X, LINE 25 The consolidated audited financial statements did not include a FIN 48 footnote disclosure as the liability was determined not material for reporting purposes. true true false false false false false false false 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 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. 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 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 false false true false true false false false false false false false false true true false false false None