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JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.

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Company Details

Name: JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 19 Oct 1982 (43 years ago)
Business ID: 506110
ZIP code: 39069
County: Jefferson
State of Incorporation: MISSISSIPPI
Principal Office Address: 405 Main Street, FayetteFayette, MS 39069

Agent

Name Role Address
Katrina Collins Agent 405 Main Street, Fayette, Fayette, MS 39069

Incorporator

Name Role Address
JIMMIE L GOODSON Incorporator ROUTE 2 BOX 156, FAYETTE, MS
ROGERS W KING Incorporator 649 MAIN ST, FAYETTE, MS
SYLVEST GAINES Incorporator ROUTE 2 BOX 18, LORMAN, MS

President

Name Role Address
Regina Reed President PO Box 1104, Fayette, MS 39069

Vice President

Name Role Address
James Walker Vice President PO Box 927, Washington, MS 39190

Treasurer

Name Role Address
Arnell Harried Treasurer PO Box 325, Lorman, MS 39096

Director

Name Role Address
Ella Hudson Director 340 Harriston Road, Fayette, MS 39069
Linda Coffie Director PO Box 222, Fayette, MS 39069
Thelma Gales Director PO Box 772, Fayette, MS 39069
Marke Robertson Director 411 B Street, Natchez, MS 39120
Mary Taylor Director 114 Burkhart, Natchez, MS 39120
Faye Brown Director 196 Covenant Road, Lorman, MS 39096
Derrick Shelvy Director 119 Green Pastures Drive, Fayette, MS 39069
Errol Pierce Director 2236 Hwy 33, Fayette, MS 39069
Carlesha Jackson Director PO Box 691, Fayette, MS 39069

Chief Financial Officer

Name Role Address
Charo Jackson Chief Financial Officer 808 Kentwood Lane, Natchez, MS 39120

Chief Executive Officer

Name Role Address
Katrina Collins Chief Executive Officer PO Box 641, Fayette, MS 39069

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
LALMJCFGJZV5
CAGE Code:
48WE9
UEI Expiration Date:
2026-03-06

Business Information

Activation Date:
2025-03-10
Initial Registration Date:
2005-12-27

National Provider Identifier

NPI Number:
1538924840
Certification Date:
2024-05-02

Authorized Person:

Name:
MS. DEBORAH ANN GAMBLE
Role:
CREDENTAILING
Phone:

Taxonomy:

Selected Taxonomy:
261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary:
Yes

Contacts:

Fax:
6017869980

Form 5500 Series

Employer Identification Number (EIN):
640667610
Plan Year:
2012
Number Of Participants:
12
Plan Year:
2011
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
14
Sponsors Telephone Number:

Filings

Type Status Filed Date Description
Reinstatement Filed 2023-05-05 Reinstatement For JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Admin Dissolution Admin Action 2023-01-13 Charities Dissolution 79-11-509(4)(b)
See File Filed 1985-06-12 See File
Name Reservation Form Filed 1982-10-19 Name Reservation

USAspending Awards / Financial Assistance

Date:
2023-08-29
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2023 BRIDGE ACCESS PROGRAM
Obligated Amount:
37874.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2023-06-07
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
DELTA STATE RURAL DEVELOPMENT NETWORK GRANT PROGRAM (DELTA)
Obligated Amount:
2142880.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2023-05-18
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2023 EXPANDING COVID-19 VACCINATION
Obligated Amount:
177570.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2021-09-20
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
HEALTH CENTER INFRASTRUCTURE SUPPORT
Obligated Amount:
601409.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2021-09-10
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2021 ENDING THE HIV EPIDEMIC - PRIMARY CARE HIV PREVENTION
Obligated Amount:
931089.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Tax Exempt

Employer Identification Number (EIN) :
64-0667610
Classification:
Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Ruling Date:
1986-08
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Paycheck Protection Program

Date Approved:
2020-04-27
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
813000
Current Approval Amount:
813000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
822236.58

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Date of last update: 19 Apr 2025

Sources: Mississippi Secretary of State