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  5. JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.

JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.

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

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC. 2012 640667610 2014-05-20 JEFFERSON COMPREHENSIVE HEALTH CENTER, INC. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-05-31
Business code 621111
Plan sponsor’s address P O BOX 98, FAYETTE, MS, 39069

Signature of
Role Plan administrator
Date 2014-05-20
Name of individual signing SHIRLEY ELLIS-STAMPLEY
Valid signature Filed with authorized/valid electronic signature
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC. 2011 640667610 2014-05-20 JEFFERSON COMPREHENSIVE HEALTH CENTER, INC. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-05-31
Business code 621111
Sponsor’s telephone number 6017863575
Plan sponsor’s address P O BOX 98, FAYETTE, MS, 39069

Plan administrator’s name and address
Administrator’s EIN 640667610
Plan administrator’s name JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Plan administrator’s address P O BOX 98, FAYETTE, MS, 39069
Administrator’s telephone number 6017863575

Signature of
Role Plan administrator
Date 2014-05-20
Name of individual signing SHIRLEY ELLIS-STAMPLEY
Valid signature Filed with authorized/valid electronic signature
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC. 2010 640667610 2014-05-20 JEFFERSON COMPREHENSIVE HEALTH CENTER, INC. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-05-31
Business code 621111
Sponsor’s telephone number 6017863575
Plan sponsor’s address P O BOX 98, FAYETTE, MS, 39069

Plan administrator’s name and address
Administrator’s EIN 640667610
Plan administrator’s name JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Plan administrator’s address P O BOX 98, FAYETTE, MS, 39069
Administrator’s telephone number 6017863575

Signature of
Role Plan administrator
Date 2014-05-20
Name of individual signing SHIRLEY ELLIS-STAMPLEY
Valid signature Filed with authorized/valid electronic signature
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC. 2010 640667610 2014-05-20 JEFFERSON COMPREHENSIVE HEALTH CENTER, INC. 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-05-31
Business code 621111
Sponsor’s telephone number 6017863475
Plan sponsor’s address P O BOX 98, FAYETTE, MS, 39069

Plan administrator’s name and address
Administrator’s EIN 640667610
Plan administrator’s name JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Plan administrator’s address P O BOX 98, FAYETTE, MS, 39069
Administrator’s telephone number 6017863475

Signature of
Role Plan administrator
Date 2014-05-20
Name of individual signing SHIRLEY ELLIS-STAMPLEY
Valid signature Filed with authorized/valid electronic signature

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

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

FAIN Awarding Agency Assistance Listings Start Date End Date Description
C12CS21877 Department of Health and Human Services 93.501 - AFFORDABLE CARE ACT (ACA) GRANTS FOR SCHOOL-BASED HEALTH CENTER CAPITAL EXPENDITURES 2011-07-01 2013-06-30 AFFORDABLE CARE ACT (ACA) GRANTS FOR SCHOOL-BASED HEALTH CENTERS CAPITAL PROGRAM
Recipient JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Recipient Name Raw JEFFERSON COMPREHENSIVE HEALTH CENTER, INC
Recipient UEI LALMJCFGJZV5
Recipient DUNS 183429216
Recipient Address P.O. BOX 98, FAYETTE, JEFFERSON, MISSISSIPPI, 39069-0098, UNITED STATES
Obligated Amount 497470.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
C81CS13364 Department of Health and Human Services 93.703 - ARRA – GRANTS TO HEALTH CENTER PROGRAMS 2009-06-29 2011-06-28 ARRA - CAPITAL IMPROVEMENT PROGRAM
Recipient JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Recipient Name Raw JEFFERSON COMPREHENSIVE HEALTH CENTER, INC
Recipient UEI LALMJCFGJZV5
Recipient DUNS 183429216
Recipient Address P.O. BOX 98, FAYETTE, JEFFERSON, MISSISSIPPI, 39069-0098, UNITED STATES
Obligated Amount 529335.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
H8BCS12055 Department of Health and Human Services 93.703 - ARRA – GRANTS TO HEALTH CENTER PROGRAMS 2009-03-27 2011-03-26 ARRA - INCREASE SERVICES TO HEALTH CENTERS
Recipient JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Recipient Name Raw JEFFERSON COMPREHENSIVE HEALTH CENTER, INC
Recipient UEI LALMJCFGJZV5
Recipient DUNS 183429216
Recipient Address P.O. BOX 98, FAYETTE, JEFFERSON, MISSISSIPPI, 39069-0098, UNITED STATES
Obligated Amount 239858.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
D60RH08549 Department of Health and Human Services 93.912 - RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK DEVELOPMENT AND SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT PROGRAM 2007-09-01 2013-07-31 DELTA STATE RURAL DEVELOPMENT NETWORK GRANT PROGRAM (DELTA)
Recipient JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Recipient Name Raw JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Recipient UEI LALMJCFGJZV5
Recipient DUNS 183429216
Recipient Address P.O. BOX 98, FAYETTE, JEFFERSON, MISSISSIPPI, 39069-0098, UNITED STATES
Obligated Amount 2553500.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
H80CS00582 Department of Health and Human Services 93.224 - CONSOLIDATED HEALTH CENTERS (COMMUNITY HEALTH CENTERS, MIGRANT HEALTH CENTERS, HEALTH CARE FOR THE HOMELESS, PUBLIC HOUSING PRIMARY CARE, AND SCHOOL BASED HEALTH CENTERS) 2002-06-01 2013-05-31 HEALTH CENTER CLUSTER
Recipient JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Recipient Name Raw JEFFERSON COMPREHENSIVE HEALTH CENTER, INC
Recipient UEI LALMJCFGJZV5
Recipient DUNS 183429216
Recipient Address P.O. BOX 98, FAYETTE, JEFFERSON, MISSISSIPPI, 39069
Obligated Amount 22117737.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
64-0667610 Corporation Unconditional Exemption PO BOX 98, FAYETTE, MS, 39069-0098 1986-08
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
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)
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2023-05
Asset 5,000,000 to 9,999,999
Income 10,000,000 to 49,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period May
Asset Amount 8397297
Income Amount 11528298
Form 990 Revenue Amount 11528298
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name JEFFERSON COMPREHENSIVE HEALTH CENTER
EIN 64-0667610
Tax Period 202305
Filing Type E
Return Type 990
File View File
Organization Name JEFFERSON COMPREHENSIVE HEALTH CENTER
EIN 64-0667610
Tax Period 202205
Filing Type E
Return Type 990
File View File
Organization Name JEFFERSON COMPREHENSIVE HEALTH CENTER
EIN 64-0667610
Tax Period 202005
Filing Type E
Return Type 990
File View File
Organization Name JEFFERSON COMPREHENSIVE HEALTH CENTER
EIN 64-0667610
Tax Period 201905
Filing Type E
Return Type 990
File View File
Organization Name JEFFERSON COMPREHENSIVE HEALTH CENTER
EIN 64-0667610
Tax Period 201705
Filing Type E
Return Type 990
File View File
Organization Name JEFFERSON COMPREHENSIVE HEALTH CENTER
EIN 64-0667610
Tax Period 201605
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4012557208 2020-04-27 0470 PPP 405 MAIN ST, FAYETTE, MS, 39069-5576
Loan Status Date 2021-07-08
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 813000
Loan Approval Amount (current) 813000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39638
Servicing Lender Name United Mississippi Bank
Servicing Lender Address 75 Melrose Montebello Pkwy, NATCHEZ, MS, 39120-4747
Rural or Urban Indicator R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address FAYETTE, JEFFERSON, MS, 39069-5576
Project Congressional District MS-02
Number of Employees 104
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 39638
Originating Lender Name United Mississippi Bank
Originating Lender Address NATCHEZ, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 822236.58
Forgiveness Paid Date 2021-06-11

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Date of last update: 12 Mar 2025

Sources: Mississippi Secretary of State

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