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  5. BROOKHAVEN UROLOGY, P.A.

BROOKHAVEN UROLOGY, P.A.

Company Details

Name: BROOKHAVEN UROLOGY, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 16 Feb 1989 (36 years ago)
Business ID: 561383
ZIP code: 39601
County: Lincoln
State of Incorporation: MISSISSIPPI
Principal Office Address: 425 Hwy. 51 NorthBrookhaven, MS 39601

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2023 640769820 2024-07-03 BROOKHAVEN UROLOGY, P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2024-07-03
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-03
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2022 640769820 2023-05-24 BROOKHAVEN UROLOGY, P.A. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2023-05-24
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2021 640769820 2022-05-05 BROOKHAVEN UROLOGY, P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2022-05-05
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2020 640769820 2021-06-29 BROOKHAVEN UROLOGY, P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2021-06-29
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-29
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2019 640769820 2020-07-02 BROOKHAVEN UROLOGY, P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2020-07-02
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-02
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2018 640769820 2019-05-15 BROOKHAVEN UROLOGY, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2019-05-15
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-15
Name of individual signing LEANNE JAMES
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2017 640769820 2018-07-03 BROOKHAVEN UROLOGY, P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2018-07-03
Name of individual signing LEANNE
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2016 640769820 2017-10-04 BROOKHAVEN UROLOGY, P.A. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, BROOKHAVEN, MS, 39601
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2015 640769820 2016-10-05 BROOKHAVEN UROLOGY, P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, P.O. BOX 3340, BROOKHAVEN, MS, 396012350

Signature of
Role Plan administrator
Date 2016-10-05
Name of individual signing JEFFERY BOYD M.D.
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN UROLOGY, P.A. 401(K) PLAN 2014 640769820 2015-10-13 BROOKHAVEN UROLOGY, P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, P.O. BOX 3340, BROOKHAVEN, MS, 396012350

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing JEFFERY BOYD M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-13
Name of individual signing JEFFERY BOYD M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/25/20140725152910P030018061615001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, P.O. BOX 3340, BROOKHAVEN, MS, 396012350

Signature of
Role Plan administrator
Date 2014-07-25
Name of individual signing JEFFERY BOYD, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-25
Name of individual signing JEFFERY BOYD, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/09/30/20130930160917P030000258676001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, P.O. BOX 3340, BROOKHAVEN, MS, 396012350

Signature of
Role Plan administrator
Date 2013-09-30
Name of individual signing JEFFERY BOYD, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/30/20120730145539P030001143861001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, P.O. BOX 3340, BROOKHAVEN, MS, 396012350

Plan administrator’s name and address
Administrator’s EIN 640769820
Plan administrator’s name BROOKHAVEN UROLOGY, P.A.
Plan administrator’s address 425 HIGHWAY 51 NORTH, P.O. BOX 3340, BROOKHAVEN, MS, 396012350
Administrator’s telephone number 6018335713

Signature of
Role Plan administrator
Date 2012-07-30
Name of individual signing JEFFERY BOYD, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/18/20110718145714P040098620817001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 6018335713
Plan sponsor’s address 425 HIGHWAY 51 NORTH, P.O. BOX 3340, BROOKHAVEN, MS, 396012350

Plan administrator’s name and address
Administrator’s EIN 640769820
Plan administrator’s name BROOKHAVEN UROLOGY, P.A.
Plan administrator’s address 425 HIGHWAY 51 NORTH, P.O. BOX 3340, BROOKHAVEN, MS, 396012350
Administrator’s telephone number 6018335713

Signature of
Role Plan administrator
Date 2011-07-18
Name of individual signing JEFFERY BOYD, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-18
Name of individual signing JEFFERY BOYD, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Jeffrey G. Clark Agent 425 HWY 51 NORTH, BROOKHAVEN, MS 39601

Incorporator

Name Role Address
Robert D Church Jr Incorporator 1296 Deposit Guaranty Plz, Jackson, MS 39201

Director

Name Role Address
Jeffrey G Clark Director 425 Hwy. 51 N., Brookhaven, MS 39601

President

Name Role Address
Jeffrey G Clark President 425 Hwy. 51 N., Brookhaven, MS 39601

Secretary

Name Role Address
Jeffrey G Clark Secretary 425 Hwy. 51 N., Brookhaven, MS 39601

Treasurer

Name Role Address
Jeffrey G Clark Treasurer 425 Hwy. 51 N., Brookhaven, MS 39601

Vice President

Name Role Address
Joel D Duff Vice President 425 Highway 51 N., Brookhaven, MS 39601

Filings

Type Status Filed Date Description
Annual Report Filed 2024-01-31 Annual Report For BROOKHAVEN UROLOGY, P.A.
Annual Report Filed 2024-01-30 Annual Report For BROOKHAVEN UROLOGY, P.A.
Annual Report Filed 2023-01-24 Annual Report For BROOKHAVEN UROLOGY, P.A.
Annual Report Filed 2022-03-08 Annual Report For BROOKHAVEN UROLOGY, P.A.
Amendment Form Filed 2022-03-07 Amendment For BROOKHAVEN UROLOGY, P.A.
Annual Report Filed 2021-02-09 Annual Report For BROOKHAVEN UROLOGY, P.A.
Annual Report Filed 2020-02-17 Annual Report For BROOKHAVEN UROLOGY, P.A.
Annual Report Filed 2019-02-07 Annual Report For BROOKHAVEN UROLOGY, P.A.
Annual Report Filed 2018-02-02 Annual Report For BROOKHAVEN UROLOGY, P.A.
Annual Report Filed 2017-02-20 Annual Report For BROOKHAVEN UROLOGY, P.A.

Related by officers

Jeffrey G. Clark

Clark Investments, LLC

Robert D Church Jr

BROOKHAVEN CHILDREN'S CLINIC, P.A. SURGICAL ANESTHESIA ASSOCIATES, P.A. GRENADA FAMILY MEDICINE CLINIC CORPORATION Oxford Clinic for Women PLLC Rebel Computers, LLC Robert D. Church Jr, CPA, LLC Shippers Express Brokerage LLC HealthCare Forensics, LLC

Jeffrey G Clark

JEFFREY G. CLARK, LLC

Related by address

No related companies by address

Date of last update: 21 Dec 2024

Sources: Mississippi Secretary of State

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