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The University of Alabama Ophthalmology Services Foundation

Details

Name: The University of Alabama Ophthalmology Services Foundation
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 07 Aug 1998 (26 years ago) (Companies founded in August 1998)
Entity Number: 000-550-646
Register Number: 000550646
ZIP code: 35233 (Companies in Jefferson, 35233)
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 1720 UNIVERSITY BLVDBIRMINGHAM, AL 35233

Activities DVLP PATIENT CARE IN A GROUP PRACTICE/STUDY PROBLEMS/EYE HEALTH

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1265485999 2006-05-17 2020-08-19 PO BOX 830941, MSC #559, BIRMINGHAM, AL, 352830941, US 700 18TH STREET SOUTH, SUITE 601, BIRMINGHAM, AL, 35233, US

Contacts
Phone +1 205-325-8620
Fax 2053258333

Authorized person
Name RETT GROVER
Role OPERATIONS ADMINISTRATOR
Phone 2053258116

Taxonomy
Taxonomy Code 207W00000X - Ophthalmology Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529901300
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2023 631206956 2024-10-02 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 89
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2024-10-02
Name of individual signing SHELBY SMITH
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2022 631206956 2023-10-02 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 90
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2023-10-02
Name of individual signing SHELBY SMITH
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2021 631206956 2022-10-04 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 87
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2022-10-04
Name of individual signing SHELBY SMITH
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2020 631206956 2021-10-05 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 63
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2021-10-05
Name of individual signing RODRENA BUSH
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2020 631206956 2021-10-05 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 91
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2021-10-05
Name of individual signing RODRENA BUSH
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2020 631206956 2021-10-05 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 87
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2021-10-05
Name of individual signing RODRENA BUSH
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2019 631206956 2021-10-05 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 90
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2021-10-05
Name of individual signing RODRENA BUSH
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2017 631206956 2018-10-08 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 97
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2018-10-04
Name of individual signing CASSANDRA PAGE
Role Employer/plan sponsor
Date 2018-10-04
Name of individual signing CASSANDRA PAGE
THE UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2015 631206956 2017-11-01 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 109
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258361
Plan sponsor’s DBA name OPHTHALMOLOGY SERVICES FOUNDATION
Plan sponsor’s address 1720 UNIVERSITY BLVD STE 305, BIRMINGHAM, AL, 352331816

Signature of
Role Plan administrator
Date 2017-11-01
Name of individual signing CASSANDRA PAGE
Role Employer/plan sponsor
Date 2017-11-01
Name of individual signing CASSANDRA PAGE
UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION RETIREMENT PLAN 2014 631206956 2015-10-02 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION 119
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621320
Sponsor’s telephone number 2053258629
Plan sponsor’s address 700 EIGHTENTH ST S, SUITE 601, BIRMINGHAM, AL, 35233

Signature of
Role Plan administrator
Date 2015-10-01
Name of individual signing CASSANDRA PAGE
Role Employer/plan sponsor
Date 2015-10-01
Name of individual signing CASSANDRA PAGE

Director

Name Role Address
BAKER, CARLTON Director 321 VESCLUB DRIVEBIRMINGHAM, AL 35216
DRENNEN, FELIX Director 115 OFFICE PARK DRIVEBIRMINGHAM, AL 35223
FERNIANY, WILLIAM Director 500 22ND STREET SOUTH, SUITE 408BIRMINGHAM, AL 35233
GIRKIN, CHRISTOPHER Director 1720 UNIVERSITY BOULEVARD, SUITE 601BIRMINGHAM, AL 35294-0009
SPRABERRY, BRIAN Director 1720 UNIVERSITY BOULEVARDBIRMINGHAM, AL 35233
AGARWAL, ANUPAM Director 510 20TH STREET SOUTH STE 1203BIRMINGHAM, AL 35294

Agent

Name Role Address
EARNHARDT, CAMERON T Agent 701 20TH STREET SUITE 820BIRMINGHAM, AL 35233

Incorporator

Name Role Address
POOL, JAMES M Incorporator 1901 SIXTH AVENUE NORTH/2400 REGIONSBIRMINGHAM, AL 35203-2618

Related by officers

BAKER, CARLTON

Marvyn Parkway Baptist Church, Inc.

FERNIANY, WILLIAM

Alabama Care Plan The Eye Foundation, Inc.

GIRKIN, CHRISTOPHER

The Callahan Eye Hospital Health Care Authority The Eye Foundation, Inc.

SPRABERRY, BRIAN

The Callahan Eye Hospital Health Care Authority

AGARWAL, ANUPAM

Saranu Medical Associates, Inc.

EARNHARDT, CAMERON T

Alabama Care Plan Alabama Care Network Southeast Alabama Care Network Central Alabama Care Network East

POOL, JAMES M

The Alabama Service Project, Inc. Concierge at Home, LLC The A+ Education Partnership First Priority of Alabama, Inc. MONTGOMERY COUNTY BAR FOUNDATION Friends of Harris Park Eastern Area Christian Ministries The William T. Graves Family Foundation Alabamians for Economic Development Alabama Voters Against Lawsuit Abuse

Related by address

1720 UNIVERSITY BLVDBIRMINGHAM, AL 35233

J. David Davidson, M.D., P.A. EyeCare Plans of Alabama, Inc. Cox-Thomas Ocular Prosthetic Laboratories, Inc. Sarah Jablecki Hays, M.D., P.C.

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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