2022-05-12T19:00:13-05:00 2021-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2020-07-01 237221695 OLE HEALTH OLEH 7072541770 1141 PEAR TREE LANE NO 100 NAPA CA 94558 HEMANTA MUNGUR CFO 7072541770 2022-05-12 1 HEMANTA MUNGUR 999009999 MICHAEL LUMSDEN P01262236 4159561500 2022-05-12 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z ALICIA HARDY 1141 PEAR TREE LANE NO 100 NAPA CA 94558 47766684 0 X WWW.OLEHEALTH.ORG X 1972 CA OLE HEALTH IS THE MEDICAL HOME FOR THE COMMUNITY'S UNDERSERVED PATIENTS. 17 17 378 19 0 0 9502269 16551956 26690833 29402943 414045 1733904 739428 60160 37346575 47748963 925000 0 0 0 22827117 26047547 0 0 294946 12250816 13440302 36002933 39487849 1343642 8261114 42727278 53712305 8305965 10759458 34421313 42952847 X OLE HEALTH IS DEDICATED TO PROVIDING HIGH-QUALITY PRIMARY HEALTH CARE TO OUR ENTIRE COMMUNITY. 0 0 19840334 0 24579193 OLE HEALTH IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC), SERVING BOTH NAPA AND SOLANO COUNTIES. WE PROVIDE PRIMARY MEDICAL CARE, INCLUDING PERINATAL AND NUTRITION SERVICES, TO OVER 30,000 PATIENTS PER YEAR. ALL OF THESE SERVICES ARE AVAILABLE AT LITTLE TO NO COST FOR PATIENTS THROUGH THE SLIDING FEE SCALE DISCOUNT PROGRAM. 3909954 0 2972079 THE DENTAL SERVICES PROGRAM AT OLE HEALTH PROVIDES AFFORDABLE DENTAL CARE TO APPROXIMATELY 6,000 PATIENTS PER YEAR. 1453209 0 1470651 THE MENTAL HEALTH PROGRAM AT OLE HEALTH PROVIDES AFFORDABLE MENTAL HEALTH CARE TO APPROXIMATELY 2,600 PATIENTS PER YEAR. 399772 0 381020 OLE HEALTH'S COMPREHENSIVE OPTOMETRY SERVICES INCLUDE DIAGNOSIS AND TREATMENT OF THE EYE AND VISUAL SYSTEM, AND A MODERN OPTICAL DISPENSARY FEATURING THE LATEST DESIGNER EYEWEAR TECHNOLOGY. OPTOMETRY SERVICES INCLUDE: EYE AND VISION EXAMS; RED-EYE EXAMS; FRAME SELECTION; AND AN OPTICAL DEPARTMENT. 399772 0 381020 25603269 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 38 0 1 378 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X HEMANTA MUNGUR 7072541774 1141 PEAR TREE LANE SUITE 200 NAPA CA 94558 ALICIA HARDY CHIEF EXECUTIVE OFFICER 38.00 2.00 X 318165 0 23930 TERESA SHINDER DO CHIEF MEDICAL OFFICER 40.00 0.00 X 293547 0 17918 GABRIELA BERMUDEZ MD MEDICAL DIRECTOR, UPVALLEY 40.00 0.00 X 257701 0 20054 VINCE FILANOVA DDS CHIEF DENTAL OFFICER 40.00 0.00 X 255139 0 13338 ROSE MACISAAC CHIEF FIN. & ADMINISTRATIVE OFFICER 31.00 9.00 X 244987 0 16487 JENNIFER ANN WILSON MD FAMILY PHYSICIAN 40.00 0.00 X 235364 0 17834 JUANCARLOS C BULLER MD FAMILY PHYSICIAN 36.00 0.00 X 226757 0 9120 TESSA WYBORNY MD PEDIATRICTIAN 40.00 0.00 X 222672 0 8857 GARY FEDLER CHIEF INFORMATION OFFICER 40.00 0.00 X 209181 0 15706 LYNETTE ELIZABETH LEIGHTON MD FAMILY PHYSICIAN 36.00 0.00 X 206041 0 9051 ANDREW TORGE CHIEF HUMAN RESOURCES OFFICER 40.00 0.00 X 200360 0 6265 MAIRA AYALA CHAIR THROUGH 6/2021 / DIRECTOR 1.00 1.00 X X 0 0 0 PETE RICHMOND VICE CHAIR / CHAIR START 6/2021 1.00 0.00 X X 0 0 0 ARTHUR ROOSA VICE CHAIR START 6/2021 1.00 0.00 X X 0 0 0 PATRICIA MCFARLAND TREASURER 1.00 0.00 X X 0 0 0 ROSE HARI SECRETARY THROUGH 4/2021 1.00 0.00 X X 0 0 0 MADELINE HERNANDEZ SECRETARY START 4/2021 1.00 0.00 X X 0 0 0 JOE CARRILLO MD BOARD MEMBER 1.00 0.00 X 0 0 0 TERESA FOSTER BOARD MEMBER THROUGH 4/2021 1.00 0.00 X 0 0 0 DEBORAH GOODIN BOARD MEMBER 1.00 0.00 X 0 0 0 RICHARD JONES BOARD MEMBER 1.00 2.00 X 0 0 0 BEATRICE LABASTIDA BOARD MEMBER 1.00 0.00 X 0 0 0 BRADY LANE BOARD MEMBER 1.00 0.00 X 0 0 0 CYNTHIA MACIAS BOARD MEMBER 1.00 0.00 X 0 0 0 MONIN MARTIN BOARD MEMBER 1.00 0.00 X 0 0 0 JO MOORE BOARD MEMBER 1.00 0.00 X 0 0 0 CEPHAS MUGERWA BOARD MEMBER 1.00 0.00 X 0 0 0 ANNA ROTH BOARD MEMBER 1.00 0.00 X 0 0 0 DAWNIELLE THORNBURGH BOARD MEMBER 1.00 0.00 X 0 0 0 LORI WILSON BOARD MEMBER 1.00 0.00 X 0 0 0 2669914 0 158560 45 0 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 75397 CONTRACTED MEDICAL SERVICES 743837 FALCON CLEANING & JANITORIAL SERVICES 675 HEGENBERGER RD 240 OAKLAND CA 94621 JANITORIAL SERVICES 263831 E CLINICAL WORKS LLC PO BOX 847950 BOSTON MA 02284 EHR SOFTWARE/IT SERVICES 233222 FONEMED LLC PO BOX 911599 DENVER CO 80291 TELEHEALTH SERVICES 222934 SVT GRUPPE PO BOX 270 NAPA CA 94558 SECURITY SERVICES 130021 6 4188971 8851537 3511448 1345087 16551956 NET PATIENT SERV REV 621400 16744139 16744139 340B COMPLIANCE REBATES 621400 6063112 6063112 CAPITATION REVENUE 621400 3800338 3800338 PHC PROVIDER INCENTIVES 621400 2795354 2795354 29402943 480969 480969 1270656 0 17721 1270656 -17721 1252935 1252935 OTHER REVENUE 900099 60160 60160 60160 47748963 29402943 0 1794064 X 1684937 573350 1111587 19591924 13050913 6315082 225929 649433 430302 213163 5968 2713296 1601457 1082579 29260 1407957 888001 502617 17339 16157 74 16083 195396 195396 4330363 3541876 788487 134327 134282 45 605941 158713 432585 14643 531604 10629 520975 2847409 1946472 900570 367 15953 4411 11542 28117 6651 21466 1435 1435 437515 390802 46713 132704 132704 MEDICAL/PHARM SUPPLIES 2810629 2589760 220869 EQUIPMENT COSTS 378373 248333 130040 DUES & SUBSCRIPTIONS 116345 8114 107006 1225 CONTINUING EDUCATION 38712 34153 4559 819322 117823 701329 170 39487849 25603269 13589634 294946 6467667 3968314 3941288 2130064 295657 911920 1245310 2757895 40000 90000 14330990 14621945 592393 623356 9203503 6354042 1906492 2849461 10220290 21032835 1671588 1671588 2015603 3054927 42727278 53712305 2903893 5590568 0 2416576 160491 0 3586472 0 1655109 2752314 8305965 10759458 X 33769551 42441834 651762 511013 34421313 42952847 42727278 53712305 X 8261114 -37580 308000 X 0 1 X 1 1 1 X 19333292 6182508 4783286 9502269 16551956 56353311 19333292 6182508 4783286 9502269 16551956 56353311 6085541 50267770 173898 386116 413870 430270 480969 1885123 18429 67528 10583 739428 60160 896128 59134562 123882671 0.85010 0.78760 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2016 AMOUNT: $ 18,429. 2017 AMOUNT: $ 67,528. 2018 AMOUNT: $ 10,583. 2019 AMOUNT: $ 739,428. 2020 AMOUNT: $ 60,160. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7500 7500 0 PART II-B, LINE 1: DURING THE JUNE 30, 2021 TAX YEAR, THE ORGANIZATION PAID INDIRECT LOBBYING EXPENSES IN RELATION TO DUES PAID TO THE CALIFORNIA PRIMARY CARE ASSOCIATION ($30,000); 25% OF THOSE DUES ($7,500) WERE INDICATED AS UTILIZED FOR LOBBYING ACTIVITIES ASSOCIATED WITH HEALTH CARE RELATED LEGISLATION. 788605 788605 4132232 3331343 800889 3080329 2345477 734852 1202337 677222 525115 2849461 DUE FROM RELATED ORGANIZATIONS 519796 QUALITY IMPROVEMENT PROGRAM RECEIVABLE 773876 DEPOSITS 20011 340B PROGRAM RECEIVABLE 685621 AMOUNTS DUE FROM THIRD-PARTY PAYORS 750845 OTHER ASSETS 304778 3054927 DEFERRED RENT 2709939 DUE TO OLE HEALTH NMTC 42375 2752314 X 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, 2021 AND 2020, 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. X 1 1 X X 0 0 0 0 0 0 0 0 0 ALICIA HARDY CHIEF EXECUTIVE OFFICER 305622 0 620 0 11923 0 11208 0 12722 0 342095 0 0 0 TERESA SHINDER DO CHIEF MEDICAL OFFICER 292927 0 620 0 0 0 10168 0 7750 0 311465 0 0 0 GABRIELA BERMUDEZ MD MEDICAL DIRECTOR, UPVALLEY 236913 0 20788 0 0 0 10581 0 9473 0 277755 0 0 0 VINCE FILANOVA DDS CHIEF DENTAL OFFICER 215144 0 5620 0 34375 0 9000 0 4338 0 268477 0 0 0 ROSE MACISAAC CHIEF FIN. & ADMINISTRATIVE OFFICER 239367 0 5620 0 0 0 4637 0 11850 0 261474 0 0 0 JENNIFER ANN WILSON MD FAMILY PHYSICIAN 230222 0 558 0 4584 0 7810 0 10024 0 253198 0 0 0 JUANCARLOS C BULLER MD FAMILY PHYSICIAN 224399 0 558 0 1800 0 9120 0 0 0 235877 0 0 0 TESSA WYBORNY MD PEDIATRICTIAN 222052 0 620 0 0 0 8857 0 0 0 231529 0 0 0 GARY FEDLER CHIEF INFORMATION OFFICER 196919 0 12262 0 0 0 8627 0 7079 0 224887 0 0 0 LYNETTE ELIZABETH LEIGHTON MD FAMILY PHYSICIAN 205483 0 558 0 0 0 8251 0 800 0 215092 0 0 0 ANDREW TORGE CHIEF HUMAN RESOURCES OFFICER 189962 0 620 0 9778 0 3564 0 2701 0 206625 0 0 0 PART I, LINE 1A VINCE FILANOVA, CHIEF DENTAL OFFICER, RECEIVED A TAXABLE HOUSING ALLOWANCE DURING THE 2020 CALENDAR YEAR, WHICH WAS REPORTED AS TAXABLE INCOME ON HIS 2020 FORM W-2. GABRIELA BERMUDEZ MD TOP FIVE HIGHEST COMPENSATED EMPLOYEE EMPLOYEE RETENTION X 50000 40000 0 0 1 JUANCARLOS C BULLER MD TOP FIVE HIGHEST COMPENSATED EMPLOYEE EMPLOYEE RETENTION X 50000 50000 0 0 1 90000 X 1 1232000 FAIR MARKET VALUE X OFFICE FURNITURE 1 103087 FAIR MARKET VALUE X GIFT CARDS 1 10000 FAIR MARKET VALUE 0 0 0 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED IN SCHEDULE M, PART I, COLUMN (B). FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION UTILIZED A PROFESSIONAL ACCOUNTING FIRM TO PREPARE THE FORM 990, WHO WORKED IN CONJUNCTION WITH THE ORGANIZATION'S FINANCE AND ACCOUNTING TEAM TO GATHER THE REQUIRED INFORMATION. UPON REVIEW OF THE FORM 990 AMONGST THE ORGANIZATION'S MANAGEMENT TEAM, THE FORM 990 WAS THEN SENT TO THE AUDIT & BENEFITS COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. THE AUDIT & BENEFITS COMMITTEE ALSO PRESENTS THE RESULTS OF ITS REVIEW PROCESS TO THE BOARD OF DIRECTORS, WHO RECEIVES A COPY OF THE FORM 990 PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL EMPLOYEES AND BOARD MEMBERS MUST COMPLETE AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. IT IS ALSO THE CONTINUING RESPONSIBILITY OF THE BOARD, OFFICERS, AND MANAGEMENT EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS, OUTSIDE BUSINESS INTERESTS, AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED; (2) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; (3) A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS; AND (4) THE BOARD HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. DISCLOSURE FROM EMPLOYEES OF THE ORGANIZATION SHOULD BE MADE TO THE CHIEF EXECUTIVE OFFICER (OR IF HE/SHE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR); DISCLOSURES INVOLVING DIRECTORS SHOULD BE MADE TO THE BOARD CHAIR (OR IF HE/SHE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD VICE CHAIR). CONFLICTED INDIVIDUALS ARE NOT ALLOWED TO PARTICIPATE IN THE DELIBERATION AND VOTE ON ANY MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND CF&AO 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 HUMAN RESOURCES 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. FORM 990, PART IX, LINE 11G CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 1,558,040. MANAGEMENT AND GENERAL EXPENSES 36,155. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,594,195. JANITORIAL SERVICES: PROGRAM SERVICE EXPENSES 18. MANAGEMENT AND GENERAL EXPENSES 307,456. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 307,474. CONSULTING FEES: PROGRAM SERVICE EXPENSES 31,180. MANAGEMENT AND GENERAL EXPENSES 185,589. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 216,769. LAB SERVICES: PROGRAM SERVICE EXPENSES 349,363. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 349,363. 340B DISPENSING/ADMINISTRATIVE FEES: PROGRAM SERVICE EXPENSES 1,526,078. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,526,078. INFECTIOUS WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 51,627. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,627. SECURITY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 192,673. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 192,673. BILLING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 66,614. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,614. RECRUITMENT: PROGRAM SERVICE EXPENSES 25,570. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,570. FORM 990, PART XI, LINE 9: UNREALIZED GAIN ON BENEFICIAL INTEREST IN TRUST ASSETS 308,000. OLE HEALTH FOUNDATION 1141 PEAR TREE LANE SUITE 100 NAPA CA 94558 680149424 FUNDRAISING CA 501(C)(3) LINE 7 OLE HEALTH 1 OLE HEALTH NMTC 1141 PEAR TREE LANE SUITE 100 NAPA CA 94558 815395044 NMTC FINANCING FOR EXEMPT ACTIVITIES CA 501(C)(3) LINE 12A, I OLE HEALTH 1 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE GIVING CA OLE HEALTH 1 1 0 1 1 1 0 0 0 0 0 1 1 1 1 1 0 1 0 0 OLE HEALTH FOUNDATION C 3629738 BOOK VALUE OLE HEALTH FOUNDATION E 29651000 LOAN GUARANTEE AMOUNT OLE HEALTH FOUNDATION O 314674 BOOK VALUE OLE HEALTH NMTC C 559233 BOOK VALUE OLE HEALTH NMTC D 478503 BOOK VALUE OLE HEALTH NMTC E 29651000 LOAN GUARANTEE AMOUNT OLE HEALTH NMTC K 534408 BOOK VALUE CHARITABLE REMAINDER UNITRUST (1) C 1232000 BOOK VALUE