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  5. MISSISSIPPI HOSPITAL ASSOCIATION

MISSISSIPPI HOSPITAL ASSOCIATION

Company Details

Name: MISSISSIPPI HOSPITAL ASSOCIATION
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 23 Apr 1937 (88 years ago)
Business ID: 104027
ZIP code: 39110
County: Madison
State of Incorporation: MISSISSIPPI
Principal Office Address: 116 Woodgreen CrossingMadison, MS 39110
Historical names: MS Hospital Access Payment
MHA-Escrow for PSHP

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2023 640411249 2024-08-06 MISSISSIPPI HOSPITAL ASSOCIATION 108
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683333
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2024-08-06
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2022 640411249 2023-09-12 MISSISSIPPI HOSPITAL ASSOCIATION 113
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683333
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2023-09-12
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2021 640411249 2022-10-04 MISSISSIPPI HOSPITAL ASSOCIATION 98
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683333
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2022-10-04
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2020 640411249 2021-10-14 MISSISSIPPI HOSPITAL ASSOCIATION 78
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683333
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2019 640411249 2020-07-15 MISSISSIPPI HOSPITAL ASSOCIATION 78
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683211
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2020-07-15
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2018 640411249 2019-08-14 MISSISSIPPI HOSPITAL ASSOCIATION 69
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683210
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2019-08-14
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2017 640411249 2018-10-09 MISSISSIPPI HOSPITAL ASSOCIATION 83
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683302
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2016 640411249 2017-09-14 MISSISSIPPI HOSPITAL ASSOCIATION 80
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683302
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2017-09-14
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION 401(K) PROFIT SHARING PLAN 2015 640411249 2016-08-31 MISSISSIPPI HOSPITAL ASSOCIATION 77
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Sponsor’s telephone number 6013683302
Plan sponsor’s address 116 WOOD GREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2016-08-31
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI HOSPITAL ASSOCIATION CASH BALANCE RETIREMENT PLAN 2015 640411249 2016-10-13 MISSISSIPPI HOSPITAL ASSOCIATION 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 6013683223
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522

Signature of
Role Plan administrator
Date 2016-10-13
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-13
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/09/30/20150930104109P030022118919001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683302
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2015-09-30
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/07/20151007112628P040031123287001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 6013683223
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522

Signature of
Role Plan administrator
Date 2015-10-07
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-07
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683302
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2015-08-13
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/25/20140925105413P040006390879001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 8002898884
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522

Signature of
Role Plan administrator
Date 2014-09-25
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-09-25
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/16/20140716084520P040013824079001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683211
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2014-07-16
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/02/20131002104456P040000821666001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 8002898884
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522

Signature of
Role Plan administrator
Date 2013-09-27
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-27
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/11/20130711171803P030107621477001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683302
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2013-07-11
Name of individual signing TERRI K. BARNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/11/20121011163510P030000372342001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 8002898884
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522

Plan administrator’s name and address
Administrator’s EIN 640411249
Plan administrator’s name MISSISSIPPI HOSPITAL ASSOCIATION
Plan administrator’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522
Administrator’s telephone number 8002898884

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-11
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/13/20120713135338P030007350912001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683305
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Plan administrator’s name and address
Administrator’s EIN 640411249
Plan administrator’s name MISSISSIPPI HOSPITAL ASSOCIATION
Plan administrator’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110
Administrator’s telephone number 6013683305

Signature of
Role Plan administrator
Date 2012-07-13
Name of individual signing TERRI K. BARNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/06/20111006162049P030143677905001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 6013683223
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522

Plan administrator’s name and address
Administrator’s EIN 640411249
Plan administrator’s name MISSISSIPPI HOSPITAL ASSOCIATION
Plan administrator’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522
Administrator’s telephone number 6013683223

Signature of
Role Plan administrator
Date 2011-10-06
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-06
Name of individual signing RICHARD GRIMES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/14/20111014113753P030049538503001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013683220
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Plan administrator’s name and address
Administrator’s EIN 640411249
Plan administrator’s name MISSISSIPPI HOSPITAL ASSOCIATION
Plan administrator’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110
Administrator’s telephone number 6013683220

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/04/20101004162653P070009317569001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 622000
Sponsor’s telephone number 6013603302
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110

Plan administrator’s name and address
Administrator’s EIN 640411249
Plan administrator’s name MISSISSIPPI HOSPITAL ASSOCIATION
Plan administrator’s address 116 WOODGREEN CROSSING, MADISON, MS, 39110
Administrator’s telephone number 6013603302

Signature of
Role Plan administrator
Date 2010-10-04
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/08/20101008094643P040003582968001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 6013683223
Plan sponsor’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522

Plan administrator’s name and address
Administrator’s EIN 640411249
Plan administrator’s name MISSISSIPPI HOSPITAL ASSOCIATION
Plan administrator’s address 116 WOODGREEN CROSSING, MADISON, MS, 391104522
Administrator’s telephone number 6013683223

Signature of
Role Plan administrator
Date 2010-10-07
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-07
Name of individual signing TERRI BARNETT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Richard Grimes Agent 116 WOODGREEN CROSSING, Madison, MS 39110

Incorporator

Name Role Address
A M McCarthy Incorporator E, Electric Mills, MS
A Street Incorporator V, Vicksburg, MS
Leon S Lippincott Incorporator V, Vicksburg, MS

President

Name Role Address
Kim Hoover, Ph.D., RN President 116 Woodgreen Crossing, Madison, MS 39110

Vice President

Name Role Address
Shawn Rossi Vice President 116 Woodgreen Crossing, Madison, MS 39110

Chief Financial Officer

Name Role Address
Richard Grimes Chief Financial Officer 116 Woodgreen Crossing, Madison, MS 39110

Filings

Type Status Filed Date Description
Amendment Form Filed 2024-03-19 Amendment For MISSISSIPPI HOSPITAL ASSOCIATION
Non-Profit Status Report Filed 2022-04-11 Status Report For MISSISSIPPI HOSPITAL ASSOCIATION
Amendment Form Filed 2022-02-16 Amendment For MISSISSIPPI HOSPITAL ASSOCIATION
Agent Resignation Filed 2022-02-16 Agent Resignation For SAMUEL W CAMERON
Fictitious Name Withdrawal Filed 2017-05-12 Fictitious Name Withdrawal For MISSISSIPPI HOSPITAL ASSOCIATION
Fictitious Name Withdrawal Filed 2016-06-02 Fictitious Name Withdrawal For MISSISSIPPI HOSPITAL ASSOCIATION
Fictitious Name Registration Filed 2016-06-02 Fictitious Name Registration For MISSISSIPPI HOSPITAL ASSOCIATION
Fictitious Name Registration Filed 2015-11-20 Fictitious Name Registration For MISSISSIPPI HOSPITAL ASSOCIATION
Non-Profit Status Report Filed 2010-04-15 Non-Profit Status Report
See File Filed 2003-11-05 See File

Related by officers

Richard Grimes

Camed Group, Inc. MHA Solutions, Inc. Myriad Health Alliance, LLC

Kim Hoover, Ph.D., RN

MHA Solutions, Inc.

Shawn Rossi

360 Health Full Circle LLC

Related by address

116 Woodgreen CrossingMadison, MS 39110

MHA HEALTH, RESEARCH AND EDUCATIONAL FOUNDATION, INC. DELTA HEALTH SOLUTIONS, INC. HPI COMPANY MHA Solutions, Inc. Stratagem, Inc. Rural Hospital Solutions, Inc. Solutions Management Services Mississippi True Magnolia Insurance Management Company

Date of last update: 25 Jan 2025

Sources: Mississippi Secretary of State

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