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  5. MISSISSIPPI STATE RATING BUREAU

MISSISSIPPI STATE RATING BUREAU

Company Details

Name: MISSISSIPPI STATE RATING BUREAU
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 27 Jun 1983 (42 years ago)
Business ID: 510334
ZIP code: 39216
County: Hinds
State of Incorporation: MISSISSIPPI
Principal Office Address: 2685 INSURANCE CENTER DRJACKSON, MS 39216-4906

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
INSURANCE COMPANY SUPPORTED ORGANIZATIONS 401(K) SAVINGS PLAN 2023 640678320 2024-07-08 MISSISSIPPI STATE RATING BUREAU 52
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 7692161796
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 39232

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396
INSURANCE COMPANY SUPPORTED ORGANIZATIONS 401(K) SAVINGS PLAN 2022 640678320 2023-06-09 MISSISSIPPI STATE RATING BUREAU 50
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 7692161796
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 39232

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396
INSURANCE COMPANY SUPPORTED ORGANIZATIONS 401(K) SAVINGS PLAN 2021 640678320 2022-06-10 MISSISSIPPI STATE RATING BUREAU 53
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 39232

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396
ICSO 401K SAVINGS PLAN 2020 640678320 2021-06-10 MISSISSIPPI STATE RATING BUREAU 55
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2021-06-10
Name of individual signing ALBERT CHIN
Valid signature Filed with authorized/valid electronic signature
ICSO 401K SAVINGS PLAN 2020 640678320 2021-06-10 MISSISSIPPI STATE RATING BUREAU 55
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2021-06-10
Name of individual signing ALBERT CHIN
Valid signature Filed with authorized/valid electronic signature
ICSO 401K SAVINGS PLAN 2020 640678320 2021-06-10 MISSISSIPPI STATE RATING BUREAU 55
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2021-06-10
Name of individual signing ALBERT CHIN
Valid signature Filed with authorized/valid electronic signature
ICSO 401K SAVINGS PLAN 2020 640678320 2021-06-10 MISSISSIPPI STATE RATING BUREAU 55
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2021-06-10
Name of individual signing ALBERT CHIN
Valid signature Filed with authorized/valid electronic signature
ICSO 401K SAVINGS PLAN 2019 640678320 2020-09-23 MISSISSIPPI STATE RATING BUREAU 57
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2020-09-23
Name of individual signing CHARLES P. KWOLEK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-09-18
Name of individual signing VICKI BATES
Valid signature Filed with authorized/valid electronic signature
ICSO 401K SAVINGS PLAN 2019 640678320 2020-06-18 MISSISSIPPI STATE RATING BUREAU 57
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2020-06-18
Name of individual signing VICKI BATES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-10
Name of individual signing VICKI BATES
Valid signature Filed with authorized/valid electronic signature
ICSO 401K SAVINGS PLAN 2018 640678320 2019-07-10 MISSISSIPPI STATE RATING BUREAU 58
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2019-07-10
Name of individual signing CHARLES P. KWOLEK JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-21
Name of individual signing VICKI BATES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/06/19/20180619084629P040002632749001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2018-06-19
Name of individual signing CHARLES P. KWOLEK JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-12
Name of individual signing JOE S SHUMAKER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/07/27/20170727074539P030060664775001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2017-07-27
Name of individual signing CHARLES P. KWOLEK, JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-24
Name of individual signing JOE S SHUMAKER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/08/02/20160802080832P040046632077001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2016-08-02
Name of individual signing CHARLES KWOLEK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-08-01
Name of individual signing JOE S SHUMAKER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/09/02/20150902104839P030046008689001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2015-07-24
Name of individual signing CHARLES P. KWOLEK JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-24
Name of individual signing JOE S SHUMAKER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/29/20140929130441P040008961631001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address 6455 WIRTZ ROAD, FLOWOOD, MS, 392327801

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2014-06-12
Name of individual signing CHARLES KWOLEK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-05-28
Name of individual signing JOE S SHUMAKER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/08/23/20130823153329P030130769301001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address P.O. BOX 5231, 2685 CRANE RIDGE DRIVE, JACKSON, MS, 39216

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2013-08-23
Name of individual signing CHARLES P. KWOLEK, JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-22
Name of individual signing JOE SHUMAKER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/14/20120914120107P030003351397001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address P.O. BOX 5231, 2685 CRANE RIDGE DRIVE, JACKSON, MS, 39216

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address 302 CENTRAL AVENUE, JOHNSON, RI, 02919
Administrator’s telephone number 4015281396

Signature of
Role Plan administrator
Date 2012-09-14
Name of individual signing CHARLES P. KWOLEK, JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-30
Name of individual signing JOE SHUMAKER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/08/20110608101021P030022506599001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address P.O. BOX 5231, 2685 CRANE RIDGE DRIVE, JACKSON, MS, 39216

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address TWO CENTER PLAZA, BOSTON, MA, 02108
Administrator’s telephone number 6175575540

Signature of
Role Plan administrator
Date 2011-06-08
Name of individual signing JOHN K GOLEMBESKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-03
Name of individual signing JOE SHUMAKER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/28/20100728111957P040403588737001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1978-05-01
Business code 525100
Sponsor’s telephone number 6019812915
Plan sponsor’s address P.O. BOX 5231, 2685 CRANE RIDGE DRIVE, JACKSON, MS, 39216

Plan administrator’s name and address
Administrator’s EIN 208540369
Plan administrator’s name THE NAMED FIDUCIARIES OF THE ICSO 401K PLAN
Plan administrator’s address TWO CENTER PLAZA, BOSTON, MA, 02108
Administrator’s telephone number 6175575540

Signature of
Role Plan administrator
Date 2010-07-28
Name of individual signing JOHN GOLEMBESKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-14
Name of individual signing JOE SHUMAKER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Lee Harrell Agent 6455 Wirtz Road, Flowood, MS 39232

Filings

Type Status Filed Date Description
Amendment Form Filed 2022-10-25 Amendment For MISSISSIPPI STATE RATING BUREAU
Amendment Form Filed 2006-12-27 Amendment
Amendment Form Filed 1998-01-16 Amendment
Amendment Form Filed 1988-07-11 Amendment
Amendment Form Filed 1983-08-01 Amendment
Name Reservation Form Filed 1983-06-27 Name Reservation

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
64-0678320 Corporation Unconditional Exemption 6455 WIRTZ RD, FLOWOOD, MS, 39232-7801 1984-01
In Care of Name % VICKI BATES
Group Exemption Number 0000
Subsection Board of Trade, Business League, Chamber of Commerce, Real Estate Board
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 Educational Organization, Local Association of Employees, Horticultural Organization, Business League, Voluntary Employees' Beneficiary Association (Govt. Emps.), Mutual Ditch or Irrigation Co., Cemetery Company, Other Mutual Corp. or Assoc.
Deductibility Contributions are not deductible.
Foundation All organizations except 501(c)(3)
Tax Period 2022-12
Asset 5,000,000 to 9,999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 5867325
Income Amount 3777657
Form 990 Revenue Amount 3777657
National Taxonomy of Exempt Entities -
Sort Name -

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name MISSISSIPPI STATE RATING BUREAU
EIN 64-0678320
Tax Period 202112
Filing Type E
Return Type 990O
File View File
Organization Name MISSISSIPPI STATE RATING BUREAU
EIN 64-0678320
Tax Period 201912
Filing Type E
Return Type 990O
File View File
Organization Name MISSISSIPPI STATE RATING BUREAU
EIN 64-0678320
Tax Period 201812
Filing Type E
Return Type 990O
File View File
Organization Name MISSISSIPPI STATE RATING BUREAU
EIN 64-0678320
Tax Period 201712
Filing Type E
Return Type 990O
File View File
Organization Name MISSISSIPPI STATE RATING BUREAU
EIN 64-0678320
Tax Period 201612
Filing Type E
Return Type 990O
File View File
Organization Name MISSISSIPPI STATE RATING BUREAU
EIN 64-0678320
Tax Period 201512
Filing Type E
Return Type 990O
File View File

Related by officers

Lee Harrell

AmFed Advantage Insurance Company Primewell Health Services of Mississippi, Inc.

Related by address

2685 INSURANCE CENTER DRJACKSON, MS 39216-4906

MISSISSIPPI FIRE CHIEFS ASSOCIATION

Date of last update: 12 Mar 2025

Sources: Mississippi Secretary of State

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