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  5. BLAYLOCK MEDICAL CLINIC, P.A.

BLAYLOCK MEDICAL CLINIC, P.A.

Company Details

Name: BLAYLOCK MEDICAL CLINIC, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Intent To Dissolve - Failure to File Annual Report
Effective Date: 30 Jun 1976 (49 years ago)
Business ID: 410912
ZIP code: 38701
County: Washington
State of Incorporation: MISSISSIPPI
Principal Office Address: 130 E Walker StreetGreenville, MS 38701

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLAYLOCK MEDICAL CLINIC, P.A. PROFIT SHARING PLAN 2018 640586131 2019-08-30 BLAYLOCK MEDICAL CLINIC, P.A. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-07-01
Business code 621111
Sponsor’s telephone number 6623327211
Plan sponsor’s address 130 EAST WALKER STREET, GREENVILLE, MS, 38701
BLAYLOCK MEDICAL CLINIC, P.A. PROFIT SHARING PLAN 2018 640586131 2019-02-25 BLAYLOCK MEDICAL CLINIC, P.A. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-07-01
Business code 621111
Sponsor’s telephone number 6623327211
Plan sponsor’s address 130 EAST WALKER STREET, GREENVILLE, MS, 38701
BLAYLOCK MEDICAL CLINIC, P.A. PROFIT SHARING PLAN 2017 640586131 2018-09-18 BLAYLOCK MEDICAL CLINIC, P.A. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-07-01
Business code 621111
Sponsor’s telephone number 6623327211
Plan sponsor’s address 130 EAST WALKER STREET, GREENVILLE, MS, 38701

Signature of
Role Plan administrator
Date 2018-09-18
Name of individual signing DARRELL BLAYLOCK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-09-18
Name of individual signing DARRELL BLAYLOCK
Valid signature Filed with authorized/valid electronic signature
BLAYLOCK MEDICAL CLINIC, P.A. PROFIT SHARING PLAN 2016 640586131 2017-10-12 BLAYLOCK MEDICAL CLINIC, P.A. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-07-01
Business code 621111
Sponsor’s telephone number 6623327211
Plan sponsor’s address 130 EAST WALKER STREET, GREENVILLE, MS, 38701

Signature of
Role Plan administrator
Date 2017-10-12
Name of individual signing DARRELL BLAYLOCK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-12
Name of individual signing DARRELL BLAYLOCK
Valid signature Filed with authorized/valid electronic signature
BLAYLOCK MEDICAL CLINIC, P.A. PROFIT SHARING PLAN 2015 640586131 2016-10-17 BLAYLOCK MEDICAL CLINIC, P.A. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-07-01
Business code 621111
Sponsor’s telephone number 6623327211
Plan sponsor’s address 130 EAST WALKER STREET, GREENVILLE, MS, 38701

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing DARRELL BLAYLOCK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-17
Name of individual signing DARRELL BLAYLOCK
Valid signature Filed with authorized/valid electronic signature
BLAYLOCK MEDICAL CLINIC, P.A. PROFIT SHARING PLAN 2014 640586131 2015-10-14 BLAYLOCK MEDICAL CLINIC, P.A. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-07-01
Business code 621111
Sponsor’s telephone number 6623327211
Plan sponsor’s address 130 EAST WALKER STREET, GREENVILLE, MS, 38701

Signature of
Role Plan administrator
Date 2015-10-14
Name of individual signing DARRELL BLAYLOCK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-14
Name of individual signing DARRELL BLAYLOCK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DARRELL N BLAYLOCK Agent 130 EAST WALKER ST, GREENVILLE, MS 38701

Director

Name Role Address
Darrell N Blaylock Director 29 BELMONT, Greenville, MS 38701
Mary Blaylock Director No data
John Blaylock Director No data

President

Name Role Address
Darrell N Blaylock President 29 BELMONT, Greenville, MS 38701

Secretary

Name Role
Mary Blaylock Secretary

Vice President

Name Role
Mary Blaylock Vice President

Treasurer

Name Role Address
Darrell N Blaylock Treasurer 29 BELMONT, Greenville, MS 38701

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2021-11-29 Action of Intent to Dissolve: AR: BLAYLOCK MEDICAL CLINIC, P.A.
Notice to Dissolve/Revoke Filed 2021-09-07 Notice of Intent to Dissolve: AR: BLAYLOCK MEDICAL CLINIC, P.A.
Annual Report Filed 2020-02-24 Annual Report For BLAYLOCK MEDICAL CLINIC, P.A.
Annual Report Filed 2019-03-29 Annual Report For BLAYLOCK MEDICAL CLINIC, P.A.
Annual Report Filed 2018-04-13 Annual Report For BLAYLOCK MEDICAL CLINIC, P.A.
Annual Report Filed 2017-04-14 Annual Report For BLAYLOCK MEDICAL CLINIC, P.A.
Annual Report Filed 2016-03-08 Annual Report For BLAYLOCK MEDICAL CLINIC, P.A.
Annual Report Filed 2015-10-22 Annual Report For BLAYLOCK MEDICAL CLINIC, P.A.
Annual Report Filed 2015-03-09 Annual Report For BLAYLOCK MEDICAL CLINIC, P.A.
Annual Report Filed 2014-04-02 Annual Report

Related by officers

Mary Blaylock

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John Blaylock

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Mississippi Secretary of State

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