2015-12-15T13:51:46-06:00 2015-01-31 630968374 Crow Shields Bailey PC 3742 Professional Parkway Mobile AL 36609 990 2014-02-01 630568762 Health Services Inc HEAL 3342632301 PO Drawer 70365 Montgomery AL 361070365 Gilbert F Darrington CEO 3342632301 2015-12-15 1 Teresa J Ernest P00184756 2513431012 2014 2016-03-07 17:11:31Z Gilbert F Darrington 7030 Tifton Ave Montgomery AL 36116 22409460 0 X www.hservinc.org X 1968 AL TO PROVIDE HEALTHCARE TO THE MEDICALLY UNDERSERVED 18 18 322 0 0 0 7108625 7351600 14221395 14679841 29 329941 43700 48078 21373749 22409460 0 0 0 0 13608039 14539193 0 0 0 7053917 7059947 20661956 21599140 711793 810320 20178236 19774059 3505706 3314795 16672530 16459264 TO PROVIDE HEALTHCARE TO THE MEDICALLY UNDERSERVED 0 0 14844926 14679841 HEALTHCARE AND ANCILLARY SERVICES TO THE MEDICALLY UNDERSERVED. WE SERVE APPROXIMATELY 30,000 PATIENTS 14844926 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 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 1 179 0 322 1 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X George Waldrop 3342632301 PO Drawer 70365 Montgomery AL 361070365 Anita Archie Director 1.00 0.00 X 0 0 0 William Love Director 1.00 0.00 X 0 0 0 Carole Askew Director 1.00 0.00 X 0 0 0 Michael Long Director 1.00 0.00 X 0 0 0 Sandra Savage-Berry Director 1.00 0.00 X 0 0 0 Jessie Binion Director 1.00 0.00 X 0 0 0 Jaunita Owes Director 1.00 0.00 X 0 0 0 James Brown Director 1.00 0.00 X 0 0 0 Nicolette Russell Director 1.00 0.00 X 0 0 0 Elizabeth Caldwell Director 1.00 0.00 X 0 0 0 Pamela Stewart Director 1.00 0.00 X 0 0 0 Judy W Taylor Director 1.00 0.00 X 0 0 0 Claude Douglas Treasurer 1.00 0.00 X X 0 0 0 Classie Thomas Chairperson 1.00 0.00 X X 0 0 0 Janice Durr Director 1.00 0.00 X 0 0 0 Dr Clara Young Director 1.00 0.00 X 0 0 0 Rita Gomez Lewis Director 1.00 0.00 X 0 0 0 C Bernell Mapp CEO 40.00 0.00 X 218825 0 15596 Albert Holloway CMO 40.00 0.00 X 403666 0 26532 Theodore Smith Physician 40.00 0.00 X 333289 0 26806 George Thomas Physician 40.00 0.00 X 280361 0 32589 Mahmood Zaied Physician 40.00 0.00 X 243696 0 23489 Abdulsattar Zidan Physician 40.00 0.00 X 223795 0 11789 1703632 0 136801 26 0 1 0 Priority Management Group 700 School St Pawtucket RI 02860 AR/Billing Contractor 861671 Laboratory Corp of America 3221 3rd Avenue South Birmingham AL 35222 Lab Contractor 630765 Comphealth - CHG Companies Inc PO Box 972651 Dallas TX 75397 Locum Tenum/Placement 253842 Laboratory Corp of America PO Box 12140 Burlington NC 27216 Lab Contractor 223197 Montgomery Area Community Wellness Coali 3060 Mobile Hwy Montgomery AL 36108 Wellness Case Management 112655 5 20764 7060338 270498 42989 7351600 Medicare/Medicaid Payments 621110 12191302 12191302 Self Pay 621110 1109502 1109502 Third Party Insurance 621110 791732 791732 Gift of Life 621110 191249 191249 340(B) Pharmacy Program 621110 167051 167051 229005 229005 14679841 329941 329941 Medical Records 621110 43614 43614 Miscellaneous 621110 4464 4464 48078 22409460 14727919 0 329941 X 223005 223005 12254012 9452940 2801072 130544 130544 979680 32249 947431 951952 733599 218353 33795 33795 34900 34900 3031036 1647408 1383628 107910 11507 96403 239970 239970 1518459 1166925 351534 144368 91008 53360 52918 34709 18209 109170 102869 6301 323350 215723 107627 119267 5085 114182 Medical Supplies/Pharma 1125849 1005722 120127 Other Expenses 163897 87279 76618 Dues & Subscriptions 54171 17046 37125 Miscellaneous 887 887 21599140 14844926 6754214 0 206485 140117 801673 1183129 224987 586066 1027980 963493 79023 66095 57910 450712 4212442 1944605 16798569 2267837 75046 101199 810943 750519 95620 13264892 20178236 19774059 1548849 1658341 1720168 1483039 89416 44089 147273 129326 3505706 3314795 X 16665194 16452025 7336 7239 16672530 16459264 20178236 19774059 810320 -1023585 0 X 0 1 X 1 1 1 X 12374187 19872217 6899354 7108625 7351600 53605983 12374187 19872217 6899354 7108625 7351600 53605983 53605983 4068 5045 3499 2795 329941 345348 42761 43318 41344 43700 48078 219201 54170532 61737676 0.98960 0.99580 X Part II, Line 10 - Other Income Detail Medical Records Income $43,614 Miscellaneous Income $4,464 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 289944 289944 1700163 504518 1195645 362254 230888 131366 1466654 1012492 454162 393427 196707 196720 2267837 Due from Health Services Holding Company, Inc. 227999 Due from Health Services Holding Company, Inc. 13036893 13264892 Alabama Health Care Consortium 28127 Deferred Compensation 101199 129326 22578674 169214 169214 22409460 0 22409460 22791938 169214 1023584 1192798 21599140 0 21599140 X 1 0 X X X X 0 0 0 0 0 0 0 0 0 C Bernell Mapp CEO 196617 0 22208 0 0 0 0 12000 0 3596 218825 15596 0 0 Albert Holloway CMO 239653 0 6350 0 157663 0 0 23000 0 3532 403666 26532 0 0 Theodore Smith Physician 249201 0 3882 0 80206 0 0 23000 0 3806 333289 26806 0 0 George Thomas Physician 268928 0 3933 0 7500 0 0 28600 0 3989 280361 32589 0 0 Mahmood Zaied Physician 236081 0 3865 0 3750 0 0 19500 0 3989 243696 23489 0 0 Abdulsattar Zidan Physician 209153 0 3518 0 11124 0 0 7800 0 3989 223795 11789 0 0 X 1 42989 Fair Market Value 0 0 0 0 Form 990, Part VI, Section B, line 11 The controller, CFO and CEO review support documents and audited financial statements. 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 18 Governing documents are made available to the public upon request. Form 990, Part VI, Section C, line 19 Governing documents are made available to the public upon request. Form 990, Part IX, line 11g Contracted Lab Service: Program service expenses 878,191. Management and general expenses 0. Fundraising expenses 0. Total expenses 878,191. Contracted Personnel: Program service expenses 769,217. Management and general expenses 1,383,628. Fundraising expenses 0. Total expenses 2,152,845. Alabama Healthcare Consortium LLC 2731 ML King Jr Blvd Tuscaloosa AL 35401 201031600 Technological Grants AL 501(c)3 7 Health Services Inc 0 Health Services Foundation Inc PO Drawer 70365 Montgomery AL 36107 Fundraising AL 501(c)3 Health Services Inc 0 Health Services Holding Co Inc PO Drawer 70365 Montgomery AL 36107 Promote Health Services, Inc. AL 501(c)3 Health Services Inc 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 1 1 0 0