2015-05-15T15:20:34-05:00 2014-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2013-07-01 237221695 COMMUNITY HEALTH CLINIC OLE COMM 7072541770 1141 PEAR TREE LN NO 100 NAPA CA 94558 MOLLY NELSON CFO 7072541770 2015-05-13 1 RICHARD CROGHAN P00089862 4159561500 2013 2016-03-07 17:11:31Z TANIR AMI 1141 PEAR TREE LN NO 100 NAPA CA 94558 19860766 0 X WWW.CLINICOLE.ORG X 1972 CA COMMUNITY HEALTH CLINIC OLE IS THE MEDICAL AND DENTAL HOME FOR NAPA COUNTY'S UNDERSERVED, PROVIDING HIGH-QUALITY, AFFORDABLE, COMPASSIONATE AND CULTURALLY SENSITIVE PRIMARY HEALTH CARE. 13 13 197 15 0 0 3598468 4376248 11945835 14961585 1885 5084 814364 517849 16360552 19860766 0 0 0 0 11804000 12700261 0 0 217029 3921860 3867353 15725860 16567614 634692 3293152 9689824 12944229 2113312 2074565 7576512 10869664 X COMMUNITY HEALTH CLINIC OLE IS THE MEDICAL AND DENTAL HOME FOR NAPA COUNTY'S UNDERSERVED, PROVIDING HIGH-QUALITY, AFFORDABLE, COMPASSIONATE AND CULTURALLY SENSITIVE PRIMARY HEALTH CARE. 0 0 9354781 12226777 COMMUNITY HEALTH CLINIC OLE IS A FEDERALLY QUALIFIED HEALTH CENTER(FQHC) AND THE ONLY NOT FOR PROFIT HEALTH CENTER IN NAPA COUNTY. THE CLINIC PROVIDES AFFORDABLE MEDICAL CARE TO NEARLY 26,000 PATIENTS. 1476060 2546422 THE DENTAL SERVICES PROGRAMS AT COMMUNITY HEALTH CLINIC OLE PROVIDE AFFORDABLE DENTAL CARE TO APPROXIMATELY 10,000 PATIENTS 427121 188386 THE MENTAL HEALTH PROGRAMS AT COMMUNITY HEALTH CLINIC OLE PROVIDE SERVICES TO THE COMMUNITY 293167 COMMUNITY HEALTH CLINIC OLE PROVIDES HEALTH EDUCATION VIA OUTREACH PROGRAMS TO THE COUNTY'S LOW-INCOME, UNINSURED AND UNDERINSURED RESIDENTS. 293167 11551129 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 197 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X MOLLY NELSON 7072541774 1141 PEAR TREE LN SUITE 100 NAPA CA 94558 DUNCAN MD KARYANNE O CHAIRMAN 2.00 1.00 X X 0 0 0 MOORE JO VICE CHAIRMAN 2.00 X X 0 0 0 JONES RICHARD TREASURER 2.00 X X 0 0 0 FITZPATRICK KEVIN SECRETARY 2.00 X X 0 0 0 SANCHEZ ROLANDO BOARD MEMBER 2.00 X 0 0 0 AYALA MARIA BOARD MEMBER 2.00 X 0 0 0 DAVIS VICTOR BOARD MEMBER 2.00 X 0 0 0 LOPEZ INDIRA BOARD MEMBER 2.00 X 0 0 0 TAYLOR DOUG BOARD MEMBER 2.00 X 0 0 0 BLAIR CHRISTOPHER BOARD MEMBER 2.00 X 0 0 0 FOSTER TERESA BOARD MEMBER 2.00 X 0 0 0 PEDROZA ALFREDO BOARD MEMBER 2.00 X 0 0 0 THORNBURGH DAWNIELLE BOARD MEMBER 2.00 X 0 0 0 AMI TANIR KERET CHIEF EXECUTIVE OFFICER 40.00 1.00 X 166715 0 16996 TOWNSEND COLLEEN MARIE CHIEF MEDICAL OFFICER 40.00 X 193649 0 12820 GONZALEZ PRISCILA CHIEF OPERATIONS OFFICER 40.00 X 107207 0 9972 NELSON MOLLY CHIEF FINANCIAL OFFICER 40.00 1.00 X 93126 0 9379 KNIGHT JAIMIE C CHIEF ADMINISTRATIVE OFFICER 40.00 X 0 0 0 AGUILERA PATRICIA CFO (THROUGH 9/2013) 40.00 X 130084 0 13080 HA SONIA SO YUNG MEDICAL DOCTOR 40.00 X 190945 0 14731 BERMUDEZ GABRIELA M MEDICAL DOCTOR 40.00 X 184580 0 12778 WILSON JENNIFER ANN MEDICAL DOCTOR 40.00 X 176820 0 13825 LEIGHTION LYNETTE ELIZABETH MEDICAL DOCTOR 40.00 X 119847 0 3808 LEVY REBECCA ANN MEDICAL DOCTOR 40.00 X 195938 0 7500 1558911 0 114889 14 0 1 0 0 732190 2159670 1484388 4376248 PATIENT SERVICE REVENUE 621400 14961585 14961585 14961585 5084 5084 PHC PROVIDER INCENTIVES 621400 388741 388741 OTHER REVENUE 900099 129108 129108 517849 19860766 14961585 0 522933 1191788 768802 422986 8479643 6328569 1992912 158162 138912 9747 129165 2096767 1544732 522804 29231 793151 580930 198181 14040 945 945 39788 39788 167505 66036 101469 35668 35668 353122 131084 220461 1577 601302 44113 557189 679964 577715 99560 2689 25308 13299 12009 36851 28697 8154 6555 6555 378458 206799 171659 50809 21250 29559 PHARMACEUTICAL SUPPLIES 725919 725595 324 CONTRACTED SERVICES 450130 305661 133139 11330 PROVISION FOR BAD DEBT 100000 100000 215029 98100 116929 16567614 11551129 4799456 217029 4337907 5970387 1003155 2322594 127096 431896 1948946 1883546 289098 355048 4375922 2434057 1983622 1941865 0 38893 9689824 12944229 1372341 1534671 423395 499279 317576 40615 2113312 2074565 X 7300975 10861537 275537 8127 7576512 10869664 9689824 12944229 3293152 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2652302 1076251 1576051 1387491 1033835 353656 336129 323971 12158 1941865 X 20037428 276662 -100000 176662 19860766 0 19860766 16744276 276662 276662 16467614 100000 100000 16567614 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, 2014 AND 2013, 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 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF PROVISION FOR BAD DEBT EXPENSE -100,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF PROVISION FOR BAD DEBT EXPENSE 100,000. X X X 0 0 0 0 0 0 0 0 0 AMI TANIR KERET CHIEF EXECUTIVE OFFICER 148180 0 203 0 18332 0 4314 0 12682 0 183711 0 0 0 TOWNSEND COLLEEN MARIE CHIEF MEDICAL OFFICER 153399 0 10078 0 30172 0 5788 0 7032 0 206469 0 0 0 HA SONIA SO YUNG MEDICAL DOCTOR 150077 0 1487 0 39381 0 4826 0 9905 0 205676 0 0 0 BERMUDEZ GABRIELA M MEDICAL DOCTOR 148003 0 8589 0 27988 0 0 0 12778 0 197358 0 0 0 WILSON JENNIFER ANN MEDICAL DOCTOR 134267 0 2171 0 40382 0 4640 0 9185 0 190645 0 0 0 LEVY REBECCA ANN MEDICAL DOCTOR 141663 0 203 0 54072 0 4893 0 2607 0 203438 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 AND ALL RELATED SCHEDULES AND STATEMENTS WAS PROVIDED TO 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 B, LINE 15 THE CEO AND CFO SALARIES ARE APPROVED BY THE BOARD OF DIRECTORS AFTER PERFORMANCE REVIEWS AND COMPENSATION STUDIES. THE OTHER KEY LEADERSHIP POSITIONS ARE BASED ON A COMPENSATION STUDY DONE BY AN INDEPENDENT FIRM EVERY TWO TO THREE YEARS. IF NECESSARY TO EVALUATE OUTSIDE OF THAT TIME PERIOD, THE HR DEPARTMENT WILL EVALUATE BY SOLICITING EXTERNAL COMPENSATION DATA AND PLACE THE POSITION APPROPRIATELY WITHIN THE ORGANIZATIONAL STRUCTURE. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. BOUND COPIES OF AUDITED FINANCIAL STATEMENTS ARE AVAILABLE AT THE ADMINISTRATORS DESK FOR ANYONE WHO ASKS FOR A COPY. ALSO WE PUBLISH A COMMUNITY REPORT WITH CONDENSED FINANCIAL INFORMATION INCLUDED. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. CLINIC OLE FOUNDATION 1141 PEAR TREE LN STE 100 NAPA CA 94558 680149424 FUNDRAISING CA 501(C)(3) 11-I COMMUNITY HEALTH CLINIC OLE 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 CLINIC OLE FOUNDATION C 732190 BOOK/ACTUAL VALUE