2018-10-08T17:52:16-05:00 2018-01-31 454084437 WARREN AVERETT LLC 3815 INTERSTATE CT MONTGOMERY AL 36109 990 2017-02-01 630568762 HEALTH SERVICES INC HEAL 3344205001 PO DRAWER 70365 MONTGOMERY AL 361070365 GILBERT F DARRINGTON CHIEF EXECUTIVE OFFICER 3344205001 2018-09-27 1 D CLYNTON HART JR CPA P00191509 3342712200 2018-09-27 209.136.244.2 2018-09-27 10:14:45 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1C4810B5319DD293F2DA90C2F34FBB007D307061 2017 2018-06-14 16:35:46Z GILBERT F DARRINGTON PO DRAWER 70365 MONTGOMERY AL 361070365 26277698 0 X WWW.HEALTHSERVICESINC.ORG X 1968 AL PATIENT CENTERED HEALTHCARE SYSTEM ENHANCING THE LIVES OF INDIVIDUALS AND FAMILIES BY PROVIDING ACCESS TO AFFORDABLE COMPREHENSIVE HEALTH AND WELLNESS SERVICES IN MONTGOMERY AND THE SURROUNDING AREAS. 17 17 342 18 0 0 8619108 9089226 15762866 16911703 94843 155197 35191 121572 24512008 26277698 0 0 0 0 15080400 15141735 0 0 0 8051361 7890666 23131761 23032401 1380247 3245297 21505084 24391841 2715756 2438216 18789328 21953625 HEALTH SERVICES, INC. (HSI) IS A MEDICAL HOME PROVIDING ACCESS TO AFFORDABLE PRIMARY, PREVENTIVE AND WELLNESS SERVICES DISTINGUISHED BY COMPASSION, QUALITY, INTEGRITY AND RESPECT IN MONTGOMERY AND SURROUNDING AREAS. 0 0 15087203 17033275 HSI SERVED APPROXIMATELY 30,000 PATIENTS ACCOUNTING FOR APPROXIMATELY 117,000 VISITS DURING THE YEAR. THE VISITS COVERED A BROAD RANGE OF SERVICES INCLUDING GENERAL WELLNESS AND PRIMARY CARE, PEDIATRICS, DENTISTRY, OPTOMETRY, OB/GYN AND FAMILY PLANNING AND FAMILY CARE; COUNSELING AND PSYCHIATRY FOR VARIOUS TREATMENT AND DISORDERS IN CHILDREN AND ADULTS; MILITARY AND VETERAN RESOURCES, SPECIALTY REFERRALS, ENROLLMENT SERVICES AND THE WOMEN, INFANTS & CHILDREN (WIC) PROGRAM. 15087203 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 82 0 1 342 1 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 X X SUSIE JONES 3344205001 PO DRAWER 70365 MONTGOMERY AL 36107 CHOONA LANG DIRECTOR 1.00 X 0 0 0 JANICE DURR TREASURER 1.00 X X 0 0 0 JAMES BROWN DIRECTOR 1.00 X 0 0 0 JOSIE KNOTT DIRECTOR 1.00 X 0 0 0 DAVID HUGHES DIRECTOR 1.00 X 0 0 0 MOLLY STONE DIRECTOR 1.00 X 0 0 0 JACQUELINE NAVIDAD DIRECTOR 1.00 X 0 0 0 DR WILLIAM ABERNATHY DIRECTOR 1.00 X 0 0 0 NICOLETTE RUSSELL DIRECTOR 1.00 X 0 0 0 CLAUDE DOUGLAS VICE CHAIR 1.00 X X 0 0 0 CLASSIE THOMAS PAST CHAIR 1.00 X 0 0 0 ANITA ARCHIE DIRECTOR 1.00 X 0 0 0 SANDRA BERRY SECRETARY 1.00 X X 0 0 0 JAUNITA OWES CHAIR 1.00 X X 0 0 0 JESSIE BINION DIRECTOR 1.00 X 0 0 0 WILLIAM LOVE DIRECTOR 1.00 X 0 0 0 DONNA RICH DIRECTOR 1.00 X 0 0 0 SUSIE JONES CFO 40.00 X 121421 0 0 BIANCA GRANGER COO 40.00 X 140683 0 0 GILBERT DARRINGTON CEO 40.00 X 224973 0 0 VANOSIA FAISON CHIEF MEDICAL OFFICER 40.00 X 205858 0 0 MAHMOOD ZAIED DOCTOR/CHIEF OF PEDIATRICS 76.00 X 457380 0 0 GEORGE THOMAS DOCTOR/CHIEF OF ADULT MEDICINE 40.00 X 270602 0 0 ABDULSATTAR ZIDAN DOCTOR 71.00 X 419672 0 0 THEODORE SMITH JR DOCTOR 40.00 X 278583 0 0 SHABNAM GUARD DOCTOR 80.00 X 391190 0 0 2510362 0 0 25 0 1 0 UPCHURCH CONSTRUCTION LLC 1001 MONTICELLO COURT MONTGOMERY AL 36117 RENOVATIONS 816386 LABORATORY CORPORATION OF AMERICA 3221 3RD AVENUE SOUTH BIRMINGHAM AL 35222 LAB CONTRACTOR 679915 PRIORITY MANAGEMENT GROUP 700 SCHOOL STREET PAWTUCKET RI 02860 AR/BILLING CONTRACTOR 443747 ATHENA HEALTH INC 311 ARSENAL STREET WATERTOWN MA 02472 CLOUD-BASED SYSTEMS PROVIDER 307720 MONTGOMERY COUNTY HEALTH DEPARTMENT 3060 MOBILE HIGHWAY MONTGOMERY AL 36108 OCCUPANCY COSTS 305617 5 13958 9009168 66100 62000 9089226 MEDICARE/MEDICAID 524114 12874318 12874318 SELF PAY 900099 1718751 1718751 THIRD PARTY INSURANCE 524292 1502365 1502365 340 (B) PHARMACY PROGRAM 446110 553161 553161 HEALTH MANAGEMENT REPORT 900099 216232 216232 46876 46876 16911703 154597 154597 600 0 600 600 600 MISCELLANEOUS 900099 94171 94171 MEDICAL RECORDS 900099 27401 27401 121572 26277698 17033275 0 155197 X 13380139 10575194 2804945 885401 885401 876195 680397 195798 56390 56390 96718 96718 2951571 1476604 1474967 98671 29861 68810 67745 18815 48930 1749945 1602986 146959 119686 63230 56456 43817 25289 18528 270341 270341 185587 18407 167180 SUPPLIES AND PHARMACEUT 1081979 208053 873926 MISCELLANEOUS 736580 106872 629708 EQUIPMENT RENTAL 359813 258725 101088 DUES AND SUBSCRIPTIONS 71823 22770 49053 23032401 15087203 7945198 0 1104130 1649450 2333429 2510399 343566 309003 907179 2063699 114345 122873 402360 337903 6790318 3095723 2338526 3694595 169850 0 505862 424862 13285837 13279057 21505084 24391841 1418906 1496796 1127000 941420 169850 0 2715756 2438216 X 18775089 21941875 14239 11750 18789328 21953625 21505084 24391841 X 3245297 -81000 X 0 1 X 1 1 1 X 7108625 7351600 8398385 8619108 9089226 40566944 7108625 7351600 8398385 8619108 9089226 40566944 40566944 2795 329941 130630 133267 154597 751230 43700 48078 71539 35191 121572 320080 41638254 0.97430 0.97860 X 289944 289944 1774343 739232 1035111 1911939 361406 1550533 2664087 1851222 812865 150005 143863 6142 3694595 DUE FROM HEALTH SERVICES HOLDING COMPANY, INC. 242164 NOTE RECEIVABLE - MONTGOMERY HSI INVESTMENT FUND, LLC 13036893 13279057 X PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND SIMILAR PROVISIONS OF ALABAMA LAW AND IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS AN ORGANIZATION OTHER THAN A PRIVATE FOUNDATION. AS OF AND FOR THE YEAR ENDED JANUARY 31, 2018, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS AND NO INTEREST AND PENALTIES RELATED TO INCOME TAXES. X X 1 0 0 0 0 0 0 1 0 GILBERT DARRINGTON CEO 224973 0 0 0 0 0 0 0 0 0 224973 0 0 0 VANOSIA FAISON CHIEF MEDICAL OFFICER 205858 0 0 0 0 0 0 0 0 0 205858 0 0 0 MAHMOOD ZAIED DOCTOR/CHIEF OF PEDIATRICS 339884 0 117496 0 0 0 0 0 0 0 457380 0 0 0 GEORGE THOMAS DOCTOR/CHIEF OF ADULT MEDICINE 268602 0 2000 0 0 0 0 0 0 0 270602 0 0 0 ABDULSATTAR ZIDAN DOCTOR 289676 0 129996 0 0 0 0 0 0 0 419672 0 0 0 THEODORE SMITH JR DOCTOR 254209 0 24374 0 0 0 0 0 0 0 278583 0 0 0 SHABNAM GUARD DOCTOR 382190 0 9000 0 0 0 0 0 0 0 391190 0 0 0 PART I, LINE 3 CEO HAS A WRITTEN CONTRACT THAT WAS APPROVED BY THE BOARD. PART I, LINE 7 EMPLOYED PROVIDERS (MEDICAL DOCTORS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS) RECEIVED INCENTIVES BASED UPON TOTAL ENCOUNTERS. X 1 62000 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER, CFO, AND CEO REVIEW SUPPORT DOCUMENTS AND TAX RETURN. FORM 990, PART VI, SECTION B, LINE 12C IT IS MONITORED BY THE CORPORATE COMPLIANCE OFFICER. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS UTILIZE AN INDEPENDENT NATIONAL LEGAL FIRM OF THE ORGANIZATION'S ASSOCIATION TO DETERMINE APPROPRIATE CEO COMPENSATION. OTHER KEY EMPLOYEE COMPENSATION IS DETERMINED BY USING PUBLISHED MATERIALS AND LOCAL COMPARABILITY DATA. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTUAL COSTS: PROGRAM SERVICE EXPENSES 1,476,604. MANAGEMENT AND GENERAL EXPENSES 1,474,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,951,571. FORM 990, PART XI, LINE 9: IMPAIRMENT OF GOODWILL -81,000. ALABAMA HEALTCARE CONSORTIUM LLC 2731 ML KING JR BLVD TUSCALOOSA AL 35401 201031600 TECHNOLOGICAL GRANTS AL 501(C)3 LINE 7 0 HEALTH SERVICES HOLDING CO INC 1845 CHERRY STREET MONTGOMERY AL 36106 460790158 PROMOTE HEALTH SERVICES INC AL 501(C)2 HEALTH SERVICES INC 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 HEALTH SERVICES HOLDING COMPANY INC K 330780 CASH