2016-05-16T11:05:50-05:00 2015-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2014-07-01 680149424 CLINIC OLE FOUNDATION CLIN 7076032105 1141 PEAR TREE LANE NO 100 NAPA CA 94558 MOLLY NELSON CFO 7076032105 2016-05-13 1 RICHARD CROGHAN P00089862 4159561500 2016-05-04 2014 2016-08-17 19:52:53Z OLE HEALTH FOUNDATION TANIR AMI 1141 PEAR TREE LANE NO 100 NAPA CA 94558 1600067 0 X WWW.CLINICOLE.ORG X 1987 CA FUNDRAISING & OTHER SERVICES TO SUPPORT COMMUNITY HEALTH CLINIC OLE 15 14 0 15 0 0 725359 584542 0 0 41062 65107 24265 427953 790686 1077602 732190 265231 0 0 0 0 0 0 85251 157874 87080 890064 352311 -99378 725291 2551963 3441349 187495 260231 2364468 3181118 FUNDRAISING & OTHER SERVICES TO SUPPORT COMMUNITY HEALTH CLINIC OLE 0 0 265231 265231 FUNDRAISING SERVICES IN SUPPORT OF COMMUNITY HEALTH CLINIC OLE, A HEALTH CLINIC FOR LOW INCOME INDIVIDUALS AND OTHERS WITHOUT HEALTH INSURANCE. 265231 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 4 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 15 14 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 CA X X MOLLY NELSON 7072541774 1141 PEAR TREE LANE SUITE 100 NAPA CA 94558 X PETER MCCREA PRESIDENT 2.00 X X 0 0 0 TODD ZAPOLSKI VICE PRESIDENT 2.00 X X 0 0 0 CHRISTOPHER CAPPETO TREASURER 2.00 X X 0 0 0 CYNTHIA GREGORY SECRETARY, EXECUTIVE DIRECTOR 40.00 X X 0 106668 9310 DAVID BECKSTOFFER BOARD MEMBER 1.00 X 0 0 0 KARYANNE DUNCAN MD BOARD MEMBER 1.00 2.00 X 0 0 0 CRISTINA SALAS-PORRAS HUDSON BOARD MEMBER 1.00 X 0 0 0 CLIFF LEDE BOARD MEMBER 1.00 X 0 0 0 DAN LYNCH BOARD MEMBER 1.00 X 0 0 0 MARTHA MAY BOARD MEMBER 1.00 X 0 0 0 JOHN SHAFER BOARD MEMBER 1.00 X 0 0 0 SUZANNE BESU TRUCHARD BOARD MEMBER 1.00 X 0 0 0 SLOAN UPTON BOARD MEMBER 1.00 X 0 0 0 BLAKESLEY CHAPPELLET BOARD MEMBER 1.00 X 0 0 0 TERRY HALL BOARD MEMBER 1.00 X 0 0 0 MOLLY NELSON CHIEF FINANCIAL OFFICER 1.00 40.00 X 0 123178 10164 0 229846 19474 0 0 0 0 0 41570 542972 130997 584542 65931 65931 444900 445724 -824 -824 -824 504694 41570 76741 427953 427953 1077602 0 0 493060 265231 265231 1829 1829 20447 20447 2556 2556 1949 1949 FUNDRAISING EXPENSES 36968 36968 STAFF DEV. & TRAINING 5423 5423 17908 17908 352311 265231 1829 85251 1409824 2292467 1142139 1148882 2551963 3441349 187495 260231 187495 260231 X 2364468 3181118 2364468 3181118 2551963 3441349 X 725291 -44539 135898 X 0 1 X 1 0 X X 1 CLINIC OLE 237221695 3 1 265231 0 1 265231 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X 1109804 -44539 -44539 1154343 -76741 -76741 1077602 293154 -59157 -59157 352311 0 352311 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2015 AND 2014, THE ORGANIZATION HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS SPECIAL EVENT EXPENSES TO REVENUE -76,741. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS SPECIAL EVENT EXPENSES TO REVENUE 76,741. PRIOR PERIOD BOOK RECONCILING ITEM -135,898. GALA 2015 483683 11000 472683 44537 7805 CHILI BALL 62581 30570 32011 3000 1000 20399 546264 41570 504694 3000 44537 1000 28204 76741 427953 0 COMMUNITY HEALTH CLINIC OLE 1141 PEAR TREE LN STE 100 NAPA CA 94558 237221695 501(C)(3) 265231 GENERAL SUPPORT 1 X 5 96102 FMV AT CONTRIB DATE X 49 25570 RETAIL VALUE X SUPPLIES 4 9325 DONOR ORGANIZATION 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 THERE ARE MULTIPLE VINTNERS AND WINE INDUSTRY REPRESENTATIVES SITTING ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 AND ALL RELATED SCHEDULES AND STATEMENTS WAS PROVIDED THE BOARD BEFORE FILING IN ORDER TO ALLOW SUFFICIENT TIME FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE UPDATED AND REVIEWED PERIODICALLY. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS ARE ALL AVAILABLE UPON REQUEST. 990, PART VII, SECTION A AND PART IX, STATEMENT OF FUNCTIONAL EXPENSES OFFICERS AND EMPLOYEES ARE EMPLOYED AND COMPENSATED BY COMMUNITY HEALTH CLINIC OLE (CHCO). CHCO REPORTS 100% OF THE INDIVIDUAL'S COMPENSATION ON W-2'S ISSUED BY CHCO UNDER THEIR FEDERAL TAX IDENTIFICATION NUMBER, 23-7221695. THERE ARE TWO EMPLOYEES ASSIGNED DUTIES TO CLINIC OLE FOUNDATION. AS A RESULT OF THESE ASSIGNMENTS, WAGE AND BENEFIT COSTS ARE REIMBURSED BY THE FOUNDATION TO CHCO. THE WAGE AND BENEFIT COSTS REIMBURSED BY THE FOUNDATION ARE REPORTED ON FORM 990, PART IX, STATEMENT OF FUNCTIONAL EXPENSES FOR THE TWO EMPLOYEES AS BEING COMPENSATED DIRECTLY FROM THE FILING. FORM 990, PART XI, LINE 9: PRIOR PERIOD BOOK RECONCILING ITEM 135,898. COMMUNITY HEALTH CLINIC OLE 1141 PEAR TREE LN STE 100 NAPA CA 94558 237221695 PROVIDES HEALTH CARE TO LOW INCOME AND UNINSURED RESIDENTS CA 501(C)(3) 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0