2016-08-09T11:36:47-05:00 2015-09-30 454084437 WARREN AVERETT LLC 2500 ACTON ROAD BIRMINGHAM AL 35243 990 2014-10-01 630649108 UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION PC UNIV 2057319600 PO BOX 55407 BIRMINGHAM AL 35255 MICHAEL HECKMAN CFO 2057319600 2016-07-18 1 JC ROUSE P00081132 2059794100 2016-07-18 2014 2016-12-15 16:53:06Z PATRICIA PRITCHETT PO BOX 55407 BIRMINGHAM AL 35255 651704328 0 X N/A X 1973 AL COORDINATE AND DELIVER PATIENT CARE IN A GROUP PRACTICE SETTING. 18 10 3575 79 0 0 0 0 510197043 510115019 26635230 17586745 15108420 33509129 551940693 561210893 24949115 36113858 0 0 349513145 374939068 0 0 0 157521954 149073062 531984214 560125988 19956479 1084905 845185796 827299090 463107332 479944741 382078464 347354349 COORDINATE AND DELIVER PATIENT CARE IN A GROUP PRACTICE SETTING WITHIN THE ACADEMIC ENVIRONMENT OF THE UNIVERSITY OF ALABAMA AT BIRMINGHAM. 0 0 462818206 36113858 510351064 OPERATION OF A NONPROFIT PHYSICIAN GROUP PRACTICE CLOSELY AFFILIATED WITH THE UNIVERSITY OF ALABAMA AT BIRMINGHAM. HSF CONSISTS OF ALMOST 1,209 FACULTY, FELLOWS AND PHYSICIANS OFFERING SERVICES IN 33 SPECIALTIES. THESE SERVICES ARE REINFORCED BY THE RESEARCH AND EDUCATIONAL PROGRAMS OF UAB'S ACADEMIC HEALTH CENTER, RESULTING IN STATE-OF-THE-ART CARE. 462818206 1 0 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 259 0 1 3575 1 0 0 0 0 0 0 0 0 0 0 X 18 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL F HECKMAN CFO 2057319600 500 22ND ST SOUTH STE 500 BIRMINGHAM AL 35233 CHARLES E ADAIR DIRECTOR 3.00 X 900 0 0 NEAL R BERTE DIRECTOR 4.00 X 1200 0 0 CHARLES D PERRY JR DIRECTOR 3.00 X 900 0 0 LEE J STYSLINGER III DIRECTOR 2.00 X 600 0 0 THOMAS H LOWDER DIRECTOR 0.00 X 0 0 0 DONALD M JAMES DIRECTOR 2.00 X 600 0 0 VAN L RICHEY DIRECTOR 2.00 X 600 0 0 MIMI HEAD DIRECTOR 2.00 X 600 0 0 TIM LEWIS DIRECTOR 4.00 X 1200 0 0 WILLIAM C HAZELRIG DIRECTOR 0.00 X 0 0 0 SELWYN M VICKERS MD DIRECTOR/PHYSICIAN 50.00 X 97343 898466 183997 KIRBY I BLAND MD DIRECTOR/PHYSICIAN 50.00 X 772712 233085 95403 DAVID G STANDAERT MD DIRECTOR/PHYSICIAN 50.00 X 97672 396794 85469 ISSAC W FERNIANY MD DIRECTOR/CEO UAB HS 0.00 50.00 X 0 1252047 224101 CHARLES S LANDEFELD MD DIRECTOR/PHYSICIAN 50.00 X 350311 218775 100690 CHERI L CANON MD DIRECTOR/PHYSICIAN 50.00 X 464510 230255 100225 MITCHELL B COHEN MD DIRECTOR/PHYSICIAN 50.00 X 86553 123910 20673 KEITH A JONES MD DIRECTOR/PHYSICIAN 50.00 X 318746 335769 129081 JAMES A BONNER PRESIDENT 50.00 X 500903 370054 115751 PATRICIA PRITCHETT EXECUTIVE VICE PRESIDENT 50.00 X 298104 181282 69721 MICHAEL F HECKMAN CFO 50.00 X 261581 0 47623 ROBERT J CERFOLIO MD PROFESSOR/PHYSICIAN 60.00 X 852820 78783 94525 JAMES K KIRKLIN MD PROFESSOR/PHYSICIAN 60.00 X 913939 323217 137982 MARK N HADLEY MD PROFESSOR/PHYSICIAN 60.00 X 747165 70842 67446 ROBERT J DABAL MD PROFESSOR/PHYSICIAN 60.00 X 794271 42952 68474 JAMES E DAVIES MD PROFESSOR/PHYSICIAN 60.00 X 732158 38450 61277 7295388 4794681 1602438 841 0 1 0 BRASFIELD & GORRIE INC PO BOX 11407 BIRMINGHAM AL 35246 CONSTRUCTION MANAGEMENT 5628546 IRON MOUNTAIN RECORDS MANAGEMENT P O BOX 530487 BIRMINGHAM AL 35253 RECORD MANAGEMENT 1856024 PLATINUM AIR SERVICE LLC 26840 SHOREGRASS DRIVE WESLEY CHAPEL FL 33543 AIR SERVICE 1247155 DOSTER CONSTRUCTION CO INC 2100 INTERNATIONAL PARK DRIVE BIRMINGHAM AL 35243 CONSTRUCTION MANAGEMENT 677403 PARKER BUILDING SERVICES 2912 REV ABRAHAM WOODS BLVD BIRMINGHAM AL 35203 CONSTRUCTION MANAGEMENT 461668 36 NET PATIENT REVENUE 900099 387770513 387770513 HEALTHCARE SERVICES 900099 105917213 105917213 ORGAN/TISSUE REC 900099 16427293 16427293 510115019 4691780 4691780 39877621 0 39877621 39877621 39877621 103324446 63954 90412820 80615 12911626 -16661 12894965 12894965 GAIN ON EQUITY IN CAC 900099 707366 707366 MISCELLANEOUS INCOME 900099 236045 236045 LOSS ON EQUITY IN PLTF 900099 -7311903 -7311903 -6368492 561210893 510351064 0 50859829 36113858 36113858 3847118 2652324 1194794 310227728 259581339 50646389 648176 436030 212146 46247863 35229827 11018036 13968183 10504336 3463847 921200 317366 603834 541929 541929 96272 96272 83103 83103 2374001 2374001 677848 677848 514953 514953 5457997 3645463 1812534 9661952 9661952 40758 40758 7742878 3107557 4635321 3191529 2015940 1175589 728869 354337 374532 4217836 4217836 14673100 5682341 8990759 9158493 9158493 BAD DEBT 28183606 28183606 SUPPORT SERVICES PRIMAR 25206524 25206524 MEDICAL, SURGICAL AND L 19961727 19961727 PROVIDER BASE CHARGEBAC 2992680 2992680 12645807 7829476 4816331 560125988 462818206 97307782 0 9673 7681 16415787 39341613 43030538 50297403 0 156037 20655429 18699204 75701 143839 9982533 6559588 304425667 151335297 146253902 153090370 478789404 454046251 102974897 85529531 26997932 19427573 845185796 827299090 102143693 119295136 202023574 205937144 158940065 154712461 463107332 479944741 X 382078464 347354349 382078464 347354349 845185796 827299090 X 1084905 -36618019 808999 X X 0 1 X 1 1 1 X 428974914 452831672 489179756 510197043 510115019 2391298404 428974914 452831672 489179756 510197043 510115019 2391298404 0 0 0 2391298404 9600120 6264280 6811184 11183352 44569401 78428337 9600120 6264280 6811184 11183352 44569401 78428337 664666 835395 10256175 8149311 -6368492 13537055 439239700 459931347 506247115 529529706 548315928 2483263796 0.96300 0.97300 0.03160 0.01840 X 83103 83103 560042885 560125988 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 31323 48547 70714 83103 233687 250000 250000 250000 250000 1000000 1500000 31323 48547 70714 83103 233687 214385005 2400000 -12919074 6400000 197465931 207293345 18551670 11460010 214385005 192858403 26434942 12000000 207293345 173460816 23840501 4442914 192858403 183677444 1760952 -3977580 8000000 173460816 1.00000 0.00000 0.00000 0 0 28163186 28163186 137823097 73393342 64429755 33406114 17111704 16294410 47078501 33416337 13662164 57954769 27413914 30540855 153090370 CASH AND CASH EQUIVALENTS 1910058 F POOLED INVESTMENTS - CASH EQUIVALENTS 13016006 F POOLED INVESTMENTS - ACCRUED INCOME 216226 F DEFERRED COMP. INVESTMENTS - CASH EQUIVALENTS 9412491 F INVESTMENT IN TRUST FUND 57394829 F INVESTMENT IN CACC, LLC 886759 F CERTIFICATES OF DEPOSIT 2693162 F 85529531 DEFERRED COMPENSATION 129066571 POST RETIREMENT LIABILITIES 25645890 154712461 X 495804684 -36618019 808999 -35809020 531613704 29597189 29597189 561210893 530528799 0 530528799 29597189 29597189 560125988 PART V, LINE 4: THE FOUNDATION'S BOARD-DESIGNATED ENDOWMENTS CONSIST OF THREE FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE NORMAL SPENDING POLICY FOR THE GENERAL ENDOWMENT FUND IS TO DISTRIBUTE BETWEEN 3.5 PERCENT AND 6.5 PERCENT OF THE FUND, SUBJECT TO ANNUAL RECOMMENDATION BY THE FOUNDATION'S INVESTMENT COMMITTEE TO THE BOARD. THIS SPENDING POLICY IS CONSISTENT WITH THE FOUNDATION'S OBJECTIVE TO MAINTAIN THE PURCHASING POWER OF ENDOWMENT ASSETS, AS WELL AS TO PROVIDE ADDITIONAL REAL GROWTH THROUGH INVESTMENT RETURNS. PART X, LINE 2: THE FOUNDATION IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). THE FOUNDATION HAS ADOPTED THE PROVISIONS OF THE ACCOUNTING STANDARDS CODIFICATION RELATING TO UNCERTAINTY IN INCOME TAXES. THIS GUIDANCE REQUIRES ENTITIES TO ASSESS THEIR UNCERTAIN TAX POSITIONS FOR THE LIKELIHOOD THAT THEY WOULD BE OVERTURNED UPON INTERNAL REVENUE SERVICE (IRS) EXAMINATION OR UPON EXAMINATION BY STATE TAXING AUTHORITIES. THE FOUNDATION HAS DETERMINED THAT IT DOES NOT HAVE ANY POSITIONS AT SEPTEMBER 30, 2015, THAT IT WOULD BE UNABLE TO SUBSTANTIATE. THE FOUNDATION HAS FILED ITS NOT-FOR-PROFIT TAX RETURNS FOR ALL YEARS THROUGH SEPTEMBER 30, 2014. YEARS ENDED SEPTEMBER 30, 2011, AND SUBSEQUENT REMAIN SUBJECT TO AUDIT BY TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN NET PENSION AND OTHER POSTRETIREMENT BENEFIT OBLIGATIONS 808,999. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT (INCOME) LOSS FROM DEFERRED COMPENSATION ASSETS 1,413,580. BAD DEBT EXPENSE OFFSET AGAINST REVENUES FOR AUDIT PURPOSES 28,183,606. ROUNDING 3. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT (INCOME) LOSS FROM DEFERRED COMPENSATION ASSETS 1,413,580. BAD DEBT EXPENSE OFFSET AGAINST REVENUES FOR AUDIT PURPOSES 28,183,606. ROUNDING 3. 1 UNIVERSITY OF ALABAMA AT BIRMINGHAM 1530 3RD AVENUE SOUTH BIRMINGHAM AL 35294 636005396 POLITICAL SUB 36113858 N/A N/A TO FUND RESEARCH PROJECTS 1 0 PART I, LINE 2: THE GRANTS PROVIDED TO UAB GO THROUGH HSF APPROVAL PROCESS. THE REQUEST COMES IN TO HSF CONTROLLER WHO PREPARES A "UAB TRANSFERS & CONTRIBUTION REQUEST AND APPROVES PAYMENT. THE REQUEST CONSIST OF THE DEPARTMENT, DATE, AMOUNT YTD EXPENSE AND VARIANCES TO BUDGET. ALL GRANT REQUISITIONS REGARDLESS OF AMOUNTS ARE THEN SENT TO THE HSF CFO FOR APPROVAL AND THEN TO THE EXECUTIVE VICE PRESIDENT FOR FINAL APPROVAL. THE GRANTS ARE ALSO MONITORED WITH THE AMOUNT PROVIDED VERSUS THE AMOUNT BUDGETED FOR THE FISCAL YEAR. X X 1 1 X X 0 0 0 1 0 0 0 1 0 SELWYN M VICKERS MD DIRECTOR/PHYSICIAN 41816 648832 0 182000 55527 67634 7743 149698 17231 9325 122317 1057489 0 0 KIRBY I BLAND MD DIRECTOR/PHYSICIAN 651991 214705 113967 11002 6754 7378 33930 37823 19786 3864 826428 274772 0 0 DAVID G STANDAERT MD DIRECTOR/PHYSICIAN 38772 395400 58876 0 24 1394 6092 60022 16921 2434 120685 459250 0 0 ISSAC W FERNIANY MD DIRECTOR/CEO UAB HS 0 650770 0 390995 0 210282 0 200677 0 23424 0 1476148 0 181830 CHARLES S LANDEFELD MD DIRECTOR/PHYSICIAN 279294 215900 68810 0 2207 2875 33930 53991 9157 3612 393398 276378 0 0 CHERI L CANON MD DIRECTOR/PHYSICIAN 377901 229489 85817 0 792 766 33930 38448 26182 1665 524622 270368 0 0 MITCHELL B COHEN MD DIRECTOR/PHYSICIAN 85827 85000 0 38210 726 700 0 15771 4508 394 91061 140075 0 0 KEITH A JONES MD DIRECTOR/PHYSICIAN 240304 333553 77726 750 716 1466 32318 75513 18044 3206 369108 414488 0 0 JAMES A BONNER PRESIDENT 355210 368244 143593 0 2100 1810 33930 56505 21949 3367 556782 429926 0 0 PATRICIA PRITCHETT EXECUTIVE VICE PRESIDENT 177330 180033 119866 0 908 1249 23523 39409 4626 2163 326253 222854 0 0 MICHAEL F HECKMAN CFO 207286 0 53155 0 1140 0 28198 0 19425 0 309204 0 0 0 ROBERT J CERFOLIO MD PROFESSOR/PHYSICIAN 850041 78396 0 0 2779 387 33930 36293 22779 1523 909529 116599 0 0 JAMES K KIRKLIN MD PROFESSOR/PHYSICIAN 629895 315268 0 4800 284044 3149 69930 53584 12405 2063 996274 378864 0 0 MARK N HADLEY MD PROFESSOR/PHYSICIAN 441635 70217 302898 0 2632 625 33930 11834 20754 928 801849 83604 0 0 ROBERT J DABAL MD PROFESSOR/PHYSICIAN 545208 42843 248000 0 1063 109 33930 8355 5685 20504 833886 71811 0 0 JAMES E DAVIES MD PROFESSOR/PHYSICIAN 396268 38400 335432 0 458 50 33930 6517 20049 781 786137 45748 0 0 PART I, LINE 1A DISCRETIONARY SPENDING ACCOUNTS: SOME EMPLOYED PHYSICIANS (INCLUDING PHYSICIAN DIRECTORS) HAVE ACCESS TO PROFESSIONAL DEVELOPMENT FUNDS WHICH ARE USED TO ADVANCE THEIR PROFESSIONAL SKILLS. AMOUNTS ARE SPENT ON COMPUTER EQUIPMENT, JOURNALS, SUBSCRIPTIONS AND TRAVEL EXPENSES TO ATTEND CONFERENCES AND LECTURES. ALL REQUESTS FOR REIMBURSEMENT ARE REVIEWED FOR COMPLIANCE WITH CURRENT POLICY AND IRS GUIDANCE BEFORE THEY ARE PAID. SOCIAL CLUB DUES: A FEW PHYSICIAN LEADERS (INCLUDING SOME PHYSICIAN DIRECTORS) ARE MEMBERS OF SOCIAL/BUSINESS CLUBS. THEY UTILIZE THESE FACILITIES FOR BUSINESS MEETINGS AND EVENTS DURING THE YEAR. ALL REQUESTS FOR REIMBURSEMENT ARE REVIEWED FOR COMPLIANCE WITH CURRENT POLICY AND IRS GUIDANCE BEFORE THEY ARE PAID. PART I, LINE 5 MANY OF OUR EMPLOYED PHYSICIANS (INCLUDING SOME DIRECTORS) HAVE INCENTIVE PLANS THAT PAY ADDITIONAL AMOUNTS BASED ON ACHIEVING SPECIFIC CLINICAL, ACADEMIC AND RESEARCH MEASURES. THESE INCENTIVE PLANS ARE REVIEWED ANNUALLY WITH THE COMPENSATION COMMITTEE. SOME OF THESE PLANS MAKE PAYMENTS BASED ON CLINICAL PRODUCTIVITY. PART I, LINE 7 MANY OF OUR EMPLOYED PHYSICIANS (INCLUDING SOME DIRECTORS) HAVE INCENTIVE PLANS THAT PAY ADDITIONAL AMOUNTS BASED ON ACHIEVING SPECIFIC CLINICAL, ACADEMIC AND RESEARCH MEASURES. THESE INCENTIVE PLANS ARE REVIEWED ANNUALLY WITH THE COMPENSATION COMMITTEE. PART II, LINE 9: FOR FISCAL YEAR 2015 COMPENSATION FOR DR. ISAAC W. FERNIANY INCLUDES $181,830 WHICH IS A ONE-TIME PAYMENT FROM HIS TEBA RETIREMENT PLAN. A THE MEDICAL CLINIC BOARD OF THE CITY OF BIRMINGHAM - UAHSF 621375181 NONEAVAIL 2011-09-07 210490000 PRIOR ISSUE REFUND AND FINANCING 0 0 0 A 210490000 38089942 1910058 1 1 0 1 A 0 1 0 0 0.01440 0.00000 0.01440 0 1 0.01390 0 1 A 0 0 0 1 1 0 0 0 0 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: THE MEDICAL CLINIC BOARD OF THE CITY OF BIRMINGHAM - UAHSF DATE THE REBATE COMPUTATION WAS PERFORMED: 09/30/2014 SCHEDULE K, PART IV, ARBITRAGE, LINE 2C: REBATE REPORT DATED SEPTEMBER 30, 2015 SELWYN VICKERS RECRUITING LOAN X 250000 156037 0 1 1 156037 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW AND IS AN AGENDA ITEM AT THE REGULARLY SCHEDULED BOARD MEETING OPEN FOR ANY DISCUSSION BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, PRINCIPAL OFFICERS AND COMMITTEE MEMBERS WITH BOARD DELEGATED POWERS ANNUALLY SIGN THE CONFLICT OF INTEREST CERTIFICATE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE MEETS ANNUALLY TO ENSURE THAT INDIVIDUAL COMPENSATION FOR PHYSICIANS, OFFICERS AND OTHER EXECUTIVES IS REASONABLE AND APPROPRIATE FOR A NON-PROFIT ORGANIZATION. THE COMPENSATION COMMITTEE PRESENTS AN ANNUAL REPORT TO THE BOARD OF DIRECTORS FOR THEIR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 AS A GENERAL RULE, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. ANY WRITTEN REQUEST BY THE PUBLIC WOULD BE REVIEWED AND ACTED UPON BY THE BOARD. FORM 990, PART XI, LINE 9: OTHER COMPREHENSIVE INCOME/LOSS 808,999. 990, PART XI, LINE 2C THE BOARD OF DIRECTORS HAS A SEPARATE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS FUNCTION HAS NOT CHANGED FROM PRIOR YEARS. UAB HEALTH SYSTEM 500 22ND STREET SOUTH SUITE 408 BIRMINGHAM AL 35233 631182994 HEALTHCARE MANAGEMENT AL 501(C)(3) LINE 7 N/A 0 UNIVERSITY OF ALABAMA AT BIRMINGHAM 1530 3RD AVENUE SOUTH BIRMINGHAM AL 35294 636005396 PUBLIC UNIVERSITY AL POLITICAL SUB N/A N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 UNIVERSITY OF ALABAMA AT BIRMINGHAM B 36113858 FMV - CASH UNIVERSITY OF ALABAMA AT BIRMINGHAM K 4269092 FMV - CASH UNIVERSITY OF ALABAMA AT BIRMINGHAM P 18952000 FMV - CASH UNIVERSITY OF ALABAMA AT BIRMINGHAM R 21441000 FMV - CASH UNIVERSITY OF ALABAMA AT BIRMINGHAM S 65499000 FMV - CASH UAB HEALTH SYSTEM R 6255000 FMV - CASH UAB HEALTH SYSTEM S 10270000 FMV - CASH