2019-09-18T15:42:48-05:00 2019-01-31 454084437 WARREN AVERETT LLC 3815 INTERSTATE CT MONTGOMERY AL 36109 990 2018-02-01 630568762 HEALTH SERVICES INC HEAL 3344205001 PO DRAWER 70365 MONTGOMERY AL 361070365 GILBERT F DARRINGTON CHIEF EXECUTIVE OFFICER 3344205001 2019-09-16 1 D CLYNTON HART JR CPA P00191509 3342712200 2019-09-05 204.15.50.137 2019-09-16 11:38:55 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7D3D884792BB59D3DF4730019F5EBA7CA547280F 2018 2019-02-21 02:37:17Z GILBERT F DARRINGTON PO DRAWER 70365 MONTGOMERY AL 361070365 28745871 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 17 346 16 0 8299 9089226 8136589 16911703 20303098 155197 191046 121572 115138 26277698 28745871 0 0 0 0 15141735 15412804 0 0 0 7890666 10105440 23032401 25518244 3245297 3227627 24391841 27324236 2438216 2142984 21953625 25181252 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 15829038 20418236 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. 15829038 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 0 0 0 0 0 1 0 0 0 1 56 0 1 346 1 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 X X SUSIE JONES 3344205001 PO DRAWER 70365 MONTGOMERY AL 36107 DR WILLIAM ABERNATHY VICE CHAIR 1.00 X X 0 0 0 CLAUDE DOUGLAS TREASURER 1.00 X X 0 0 0 NICOLETTE RUSSELL SECRETARY 1.00 X X 0 0 0 JAUNITA OWES DIRECTOR 1.00 X 0 0 0 TRACIE ADAMS DIRECTOR 1.00 X 0 0 0 JESSIE BINION DIRECTOR 1.00 X 0 0 0 HELENOR BELL DIRECTOR 1.00 X 0 0 0 JACQUELINE NAVIDAD DIRECTOR 1.00 X 0 0 0 JANICE DURR DIRECTOR 1.00 X 0 0 0 JOSIE KNOTT DIRECTOR 1.00 X 0 0 0 JAMES BROWN DIRECTOR 1.00 X 0 0 0 MOLLY STONE DIRECTOR 1.00 X 0 0 0 SANDRA BERRY DIRECTOR 1.00 X 0 0 0 CHOONA LANG DIRECTOR 1.00 X 0 0 0 DONNA RICH DIRECTOR 1.00 X 0 0 0 CLASSIE THOMAS CHAIR 1.00 X X 0 0 0 VANOSIA FAISON CHIEF MEDICAL OFFICER 40.00 X 218745 0 0 SUSIE JONES CFO 40.00 X 132837 0 0 GILBERT DARRINGTON CEO 40.00 X 226919 0 12000 DR MAHMOOD ZAIED DOCTOR/CHIEF OF PEDIATRICS 76.00 X 507216 0 0 DR GEORGE THOMAS DOCTOR/CHIEF OF ADULT MEDI 60.00 X 274667 0 0 DR ABDULSATTAR ZIDAN DOCTOR 71.00 X 437732 0 0 DR THEODORE SMITH JR DOCTOR 40.00 X 266915 0 0 DR SHABNAM GUARD DOCTOR 80.00 X 427391 0 0 2492422 0 12000 25 0 1 0 ATHENA HEALTH INC 311 ARSENAL STREET WATERTOWN MA 02472 CLOUD-BASED SYSTEMS PROVIDER 1177238 LABORATORY CORPORATION OF AMERICA 3221 3RD AVENUE SOUTH BIRMINGHAM AL 35222 LAB CONTRACTOR 884163 MONTGOMERY COUNTY HEALTH DEPARTMENT 3060 MOBILE HIGHWAY MONTGOMERY AL 36108 OCCUPANCY COSTS 256874 MCKESSON GENERAL MEDICAL CORP 6555 STATE HWY 61 IRVING TX 75039 SUPPLIES/HEALTH INFORMATION TECHNOLOGY 243787 DIXON-SHANE LLC 8407 AUSTIN TRACY ROAD FOUNTAIN RUN KY 42133 PHARMACEUTICALS 226591 13 8112454 24135 8136589 MEDICARE/MEDICAID 524114 13509842 13509842 THIRD PARTY INSURANCE 524292 3644065 3644065 SELF PAY 900099 1941258 1941258 340 (B) PHARMACY PROGRAM 446110 902988 902988 HEALTH MANAGEMENT REPORT 900099 262319 262319 42626 42626 20303098 190086 190086 960 0 960 960 960 MISCELLANEOUS 900099 76557 76557 MEDICAL RECORDS 900099 38581 38581 115138 28745871 20418236 0 191046 X 13732623 10793585 2939038 785487 785487 894694 692248 202446 84306 84306 81210 81210 3123706 1802182 1321524 145825 42178 103647 57975 19180 38795 1581338 1548395 32943 156948 86463 70485 55056 34224 20832 48051 48051 359202 359202 201105 25647 175458 BAD DEBT EXPENSE 2392336 2392336 SUPPLIES AND PHARMACEUT 1167056 312742 854314 EQUIPMENT RENTAL 538019 423881 114138 DUES AND SUBSCRIPTIONS 106148 43871 62277 7159 4442 2717 25518244 15829038 9689206 0 1649450 3465762 2510399 2818656 309003 160420 2063699 2984567 122873 143881 337903 222134 7306247 3454924 3694595 3851323 424862 424862 13279057 13252631 24391841 27324236 1496796 1378867 941420 764117 2438216 2142984 X 21941875 25112405 11750 68847 21953625 25181252 24391841 27324236 3227627 0 X 0 1 X 1 1 1 X 7351600 8398385 8619108 9089226 8136589 41594908 7351600 8398385 8619108 9089226 8136589 41594908 41594908 329941 130630 133267 154597 190086 938521 48078 71539 35191 121572 115138 391518 42924947 0.96900 0.97430 X 324919 324919 1874090 821532 1052558 1911939 475790 1436149 2927848 2004901 922947 267451 152701 114750 3851323 DUE FROM HEALTH SERVICES HOLDING COMPANY, INC. 215238 NOTE RECEIVABLE - MONTGOMERY HSI INVESTMENT FUND, LLC 13037393 13252631 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, 2019, 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 VANOSIA FAISON CHIEF MEDICAL OFFICER 218745 0 0 0 0 0 0 0 0 0 218745 0 0 0 GILBERT DARRINGTON CEO 226919 0 0 0 0 0 12000 0 0 0 238919 0 0 0 DR MAHMOOD ZAIED DOCTOR/CHIEF OF PEDIATRICS 372220 0 134996 0 0 0 0 0 0 0 507216 0 0 0 DR GEORGE THOMAS DOCTOR/CHIEF OF ADULT MEDI 274167 0 500 0 0 0 0 0 0 0 274667 0 0 0 DR ABDULSATTAR ZIDAN DOCTOR 310236 0 127496 0 0 0 0 0 0 0 437732 0 0 0 DR THEODORE SMITH JR DOCTOR 266565 0 350 0 0 0 0 0 0 0 266915 0 0 0 DR SHABNAM GUARD DOCTOR 415191 0 12200 0 0 0 0 0 0 0 427391 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. 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 1,802,182. MANAGEMENT AND GENERAL EXPENSES 1,321,524. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,123,706. 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 438525 CASH