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 680149424 CLINIC OLE FOUNDATION CLIN 7076032105 1141 PEAR TREE LANE NO 100 NAPA CA 94558 MOLLY NELSON CFO 7076032105 2015-05-13 1 RICHARD CROGHAN P00089862 4159561500 2013 2016-04-25 22:37:26Z CYNTHIA GREGORY 1141 PEAR TREE LANE NO 100 NAPA CA 94558 853464 0 X WWW.CLINICOLE.ORG X 1987 CA FUNDRAISING & OTHER SERVICES TO SUPPORT COMMUNITY HEALTH CLINIC OLE 14 13 0 20 0 0 905823 725359 0 0 30059 41062 69371 24265 1005253 790686 508350 732190 0 0 112946 0 0 0 156941 100336 157874 721632 890064 283621 -99378 2351685 2551963 38480 187495 2313205 2364468 FUNDRAISING AND OTHER SERVICES TO SUPPORT COMMUNITY HEALTH CLINIC OLE 0 0 732190 732190 FUNDRAISING SERVICES IN SUPPORT OF COMMUNITY HEALTH CLINIC OLE, A HEALTH CLINIC FOR LOW INCOME INDIVIDUALS AND OTHERS WITHOUT HEALTH INSURANCE. 732190 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 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 2 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 14 13 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 CA X X CYNTHIA GREGORY 7076037104 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 90604 8754 TANIR AMI BOARD MEMBER 1.00 40.00 X 0 166715 16996 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 PRISCILLA UPTON BOARD MEMBER 1.00 X 0 0 0 SLOAN UPTON BOARD MEMBER 1.00 X 0 0 0 MOLLY NELSON CHIEF FINANCIAL OFFICER 1.00 40.00 X 0 93126 9379 0 350445 35129 0 0 1 0 0 34000 691359 43533 725359 41138 41138 41741 41817 -76 -76 -76 45226 34000 20961 24265 24265 790686 0 0 65327 732190 732190 933 933 6964 6964 1049 1049 4611 4611 2556 2556 1013 1013 BOOK/TAX DIFFERENCE IN 126000 126000 FUNDRAISING EXPENSES 8484 8484 STAFF DEV. & TRAINING 5355 5355 SALES TAX 909 909 890064 732190 933 156941 1333208 1409824 1018477 1142139 2351685 2551963 38480 187495 38480 187495 X 2313205 2364468 2313205 2364468 2351685 2551963 -99378 150641 0 X X 0 1 X 1 0 X X X 0 0 0 CLINIC OLE 237221695 3 1 1 1 732190 1 732190 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X 1002471 150641 40183 190824 811647 -20961 -20961 790686 951209 40183 20962 61145 890064 0 890064 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 4B - OTHER ADJUSTMENTS: RECLASS SPECIAL EVENT EXPENSES TO REVENUE -20,961. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS SPECIAL EVENT EXPENSES TO REVENUE 20,961. ROUNDING 1. GALA 2014 33595 32000 1595 1443 CHILI BALL 45631 2000 43631 1095 5000 2397 11026 79226 34000 45226 1095 5000 2397 12469 20961 24265 0 COMMUNITY HEALTH CLINIC OLE 1141 PEAR TREE LN STE 100 NAPA CA 94558 237221695 501(C)(3) 732190 GENERAL SUPPORT 1 0 0 0 0 0 0 0 0 0 TANIR AMI BOARD MEMBER 0 148180 0 203 0 18332 0 4314 0 12682 0 183711 0 0 X 4 41183 FMV AT CONTRIB DATE X SUPPLIES 2 2350 DONOR ORGANIZATION 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 TWO BOARD MEMBERS PRISCILLA UPTON AND SLOAN UPTON HAVE A FAMILY RELATIONSHIP 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 XII, LINE 2C THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. 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 0 0 0 1 0 0 0