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  5. Capstone Health Services Foundation, P.C.

Capstone Health Services Foundation, P.C.

Details

Name: Capstone Health Services Foundation, P.C.
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 09 Feb 1981 (44 years ago)
Entity Number: 000-070-282
Register Number: 000070282
Historical Names: Capstone Health Services Foundation
ZIP code: 35401
County: Tuscaloosa
Place of Formation: Tuscaloosa County
Principal Address: TUSCALOOSA, AL
Registered Office Street Address: 850 PETER BRYCE BLVDTUSCALOOSA, AL 35401

Activities MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1124763784 2022-04-28 2022-04-28 850 PETER BRYCE BLVD, TUSCALOOSA, AL, 354017457, US 711 N WASHINGTON ST, LIVINGSTON, AL, 354705409, US

Contacts
Phone +1 205-348-1770

Authorized person
Name JANNA LUMPKIN
Role CREDENTIALING SPECIALIST
Phone 2053481262

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CAPSTONE HEALTH SERVICES FOUNDATION RETIREMENT ANNUITY PLAN 2016 630810661 2017-10-13 CAPSTONE HEALTH SERVICES FOUNDATION 120
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Signature of
Role Plan administrator
Date 2017-10-13
Name of individual signing ALLISON ARENDALE
CAPSTONE HEALTH SERVICES FOUNDATION RETIREMENT ANNUITY PLAN 2015 630810661 2016-10-17 CAPSTONE HEALTH SERVICES FOUNDATION 117
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing ALLISON ARENDALE
CAPSTONE HEALTH SERVICES FOUNDATION RETIREMENT ANNUITY PLAN 2014 630810661 2015-10-09 CAPSTONE HEALTH SERVICES FOUNDATION 113
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Signature of
Role Plan administrator
Date 2015-10-09
Name of individual signing ALLISON ARENDALE
CAPSTONE HEALTH SERVICES FOUNDATION RETIREMENT ANNUITY PLAN 2013 630810661 2014-07-23 CAPSTONE HEALTH SERVICES FOUNDATION 108
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Signature of
Role Plan administrator
Date 2014-07-23
Name of individual signing ALLISON ARENDALE
CAPSTONE HEALTH SERVICES FOUNDATION RETIREMENT ANNUITY PLAN 2012 630810661 2013-10-10 CAPSTONE HEALTH SERVICES FOUNDATION 99
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Signature of
Role Plan administrator
Date 2013-10-10
Name of individual signing ALLISON ARENDALE
CAPSTONE HEALTH SERVICES FOUNDATION RETIREMENT ANNUITY PLAN 2011 630810661 2012-10-15 CAPSTONE HEALTH SERVICES FOUNDATION 94
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Plan administrator’s name and address
Administrator’s EIN 630810661
Plan administrator’s name CAPSTONE HEALTH SERVICES FOUNDATION
Plan administrator’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401
Administrator’s telephone number 2053485203

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing ALLISON ARENDALE
CAPSTONE HEALTH SERVICES FOUNDATION RETIREMENT ANNUITY PLAN 2010 630810661 2011-07-20 CAPSTONE HEALTH SERVICES FOUNDATION 92
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Plan administrator’s name and address
Administrator’s EIN 630810661
Plan administrator’s name CAPSTONE HEALTH SERVICES FOUNDATION
Plan administrator’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401
Administrator’s telephone number 2053485203

Signature of
Role Plan administrator
Date 2011-07-20
Name of individual signing ALLISON ARENDALE
CAPSTONE HEALTH SERVICES FOUNDATION RETIREMENT ANNUITY PLAN 2010 630810661 2011-07-18 CAPSTONE HEALTH SERVICES FOUNDATION 92
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Plan administrator’s name and address
Administrator’s EIN 630810661
Plan administrator’s name CAPSTONE HEALTH SERVICES FOUNDATION
Plan administrator’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401
Administrator’s telephone number 2053485203

Signature of
Role Plan administrator
Date 2011-07-15
Name of individual signing ALLISON ARENDALE
CAPSTONE HEALTH SVCS FOUNDATION RETIREMENT ANNUITY RETIREMENT ANNUITY PLAN 2009 630810661 2010-10-07 CAPSTONE HEALTH SERVICES FOUNDATION 90
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-10-01
Business code 813000
Sponsor’s telephone number 2053485203
Plan sponsor’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401

Plan administrator’s name and address
Administrator’s EIN 630810661
Plan administrator’s name CAPSTONE HEALTH SERVICES FOUNDATION
Plan administrator’s address 850 5TH AVENUE EAST, TUSCALOOSA, AL, 35401
Administrator’s telephone number 2053485203

Signature of
Role Plan administrator
Date 2010-10-06
Name of individual signing ALLISON ARENDALE

Agent

Name Role Address
FRIEND, RICHARD Agent 1300 PENN ROADHARTSELLE, AL 35640

Incorporator

Name Role
MCCALLUM, CHARLES A DMD MD Incorporator
PITTMAN, JAMES A JR MD Incorporator
COGGINS, WILMER J MD Incorporator

Events

Event Date Event Type Old Value New Value
1986-04-14 Name Change Capstone Health Services Foundation Capstone Health Services Foundation, P.C.

Related by officers

FRIEND, RICHARD

DART DISASTER SERVICES, INC.

PITTMAN, JAMES A JR MD

Medical Advancement Foundation

Related by address

TUSCALOOSA, AL

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Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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