2013-05-13T18:13:17-05:00 2012-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2011-07-01 680149424 CLINIC OLE FOUNDATION CLIN 7076032105 1141 PEAR TREE LANE NO 100 NAPA CA 94558 JOHN R SHAFER 7076032105 2013-05-10 1 RICHARD CROGHAN P00089862 4159561500 2011 2016-02-24 21:20:13Z JOHN R SHAFER 1141 PEAR TREE LANE NO 100 NAPA CA 94558 1221165 0 X WWW.CLINICOLE.ORG X 1987 CA FUNDRAISING & OTHER SERVICES TO SUPPORT COMMUNITY HEALTH CLINIC OLE 11 11 0 20 0 0 513370 531474 0 0 54171 41331 0 17257 567541 590062 509200 550000 0 0 59731 0 0 0 58086 35444 60786 604375 610786 -36834 -20724 1991088 1929691 0 0 1991088 1929691 FUNDRAISING AND OTHER SERVICES TO SUPPORT COMMUNITY HEALTH CLINIC OLE 0 0 550000 550000 FUNDRAISING SERVICES IN SUPPORT OF COMMUNITY HEALTH CLINIC OLE, A HEALTH CLINIC FOR LOW INCOME INDIVIDUALS AND OTHERS WITHOUT HEALTH INSURANCE. 550000 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 0 1 2 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 CA X X SUE PARRY 7076032105 1141 PEAR TREE LANE SUITE 260 NAPA CA 94558 X X JOHN SHAFER 2.00 X X 0 0 0 PETER MCCREA 2.00 X X 0 0 0 SUSAN CROSS 2.00 X X 0 0 0 DAN LYNCH 2.00 X X 0 0 0 CHRIS CAPPETO 2.00 X 0 0 0 KARYNNE DUNCAN MD 2.00 X 0 0 0 DANA JOHNSON 2.00 X 0 0 0 KATHY OATES 2.00 X 0 0 0 PATRICIA PERINI LONG 2.00 X 0 0 0 PRISCILLA UPTON 2.00 X 0 0 0 KATHERINE ZELAZNY 2.00 X 0 0 0 0 0 0 0 0 0 0 0 21125 510349 27890 531474 29263 29263 623082 611014 12068 12068 12068 37346 21125 20089 17257 17257 590062 0 0 58588 550000 550000 48284 48284 2700 2700 ED SEARCH COSTS 8149 8149 POSTAGE AND DELIVERY 1237 1237 416 416 610786 550000 2700 58086 546220 1039432 1444868 890259 1991088 1929691 0 0 X 1991088 1929691 1991088 1929691 1991088 1929691 X -20724 -40673 X 0 1 0 X 0 X X X 0 0 0 CLINIC OLE 237221695 3 1 1 1 550000 1 550000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 590062 610786 -20724 -40673 -40673 -61397 569478 -40673 20089 -20584 590062 0 590062 630875 20089 20089 610786 0 610786 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2012, 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 XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 20,089. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 20,089. 2011 CHILI BALL 58471 21125 37346 0 0 5000 1800 1000 12289 58471 21125 37346 5000 1800 1000 12289 20089 17257 0 COMMUNITY HEALTH CLINIC OLE 1141 PEAR TREE LN STE 100 NAPA CA 94558 237221695 501(C)(3) 550000 GENERAL SUPPORT 1 X 2 27890 FMV AT CONTRIBUTION DATE 0 0 0 0 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. OFFICER HOURS DEVOTED TO RELATED ORGANIZATIONS 990, PART VII, SECTION A, COLUMN B PRISCILLA UPTON'S TIME IS DIVIDED AS FOLLOWS: COMMUNITY HEALTH CLINIC OLE 2.00 HOURS CLINIC OLE FOUNDATION 2.00 HOURS KARYNNE DUNCAN, MD'S TIME IS DIVIDED AS FOLLOWS: COMMUNITY HEALTH CLINIC OLE 2.00 HOURS CLINIC OLE FOUNDATION 2.00 HOURS DAN LYNCH'S TIME IS DIVIDED AS FOLLOWS: COMMUNITY HEALTH CLINIC OLE 2.00 HOUR CLINIC OLE FOUNDATION 2.00 HOURS PETER MCCREA'S TIME IS DIVIDED AS FOLLOWS: COMMUNITY HEALTH CLINIC OLE 1.00 HOUR CLINIC OLE FOUNDATION 2.00 HOURS PATRICIA PERINI LONG'S TIME IS DIVIDED AS FOLLOWS: COMMUNITY HEALTH CLINIC OLE 1.00 HOUR CLINIC OLE FOUNDATION 2.00 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -40,673. 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 1 0 0 0 0 0 0 0