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  5. BROOKHAVEN SURGERY CLINIC, P.A.

BROOKHAVEN SURGERY CLINIC, P.A.

Company Details

Name: BROOKHAVEN SURGERY CLINIC, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 21 Jan 1993 (32 years ago)
Business ID: 594290
ZIP code: 39601
County: Lincoln
State of Incorporation: MISSISSIPPI
Principal Office Address: 1036 Biglane DriveBrookhaven, MS 39601

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2023 640822726 2024-04-28 BROOKHAVEN SURGERY CLINIC, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2024-04-24
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2022 640822726 2023-04-13 BROOKHAVEN SURGERY CLINIC, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2023-04-13
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2021 640822726 2022-04-01 BROOKHAVEN SURGERY CLINIC, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2022-04-01
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-04-01
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2020 640822726 2021-06-21 BROOKHAVEN SURGERY CLINIC, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2021-06-21
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-21
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2019 640822726 2020-09-11 BROOKHAVEN SURGERY CLINIC, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2020-09-11
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-09-11
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2018 640822726 2019-07-25 BROOKHAVEN SURGERY CLINIC, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2019-07-25
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-25
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2017 640822726 2018-07-24 BROOKHAVEN SURGERY CLINIC, P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2018-07-24
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-24
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2016 640822726 2017-07-03 BROOKHAVEN SURGERY CLINIC, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2017-07-03
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-03
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2015 640822726 2016-08-09 BROOKHAVEN SURGERY CLINIC, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2016-08-09
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-08-09
Name of individual signing ALENE SMITH
Valid signature Filed with authorized/valid electronic signature
BROOKHAVEN SURGERY CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2014 640822726 2015-06-30 BROOKHAVEN SURGERY CLINIC, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 D A BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2015-06-30
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-30
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/08/28/20140828111316P030033392415001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2014-08-28
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-08-28
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/08/30/20130830112825P030364062979001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Signature of
Role Plan administrator
Date 2013-08-30
Name of individual signing MICHAEL T. PEAVEY, SR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-08-30
Name of individual signing MICHAEL T. PEAVEY, SR.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/12/20120912114953P030005643844001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Plan administrator’s name and address
Administrator’s EIN 640822726
Plan administrator’s name BROOKHAVEN SURGERY CLINIC, P.A.
Plan administrator’s address 1036 BIGLANE DRIVE, BROOKHAVEN, MS, 39601
Administrator’s telephone number 6018351182

Signature of
Role Plan administrator
Date 2012-09-12
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-12
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/08/30/20110830162242P030017784642001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Plan administrator’s name and address
Administrator’s EIN 640822726
Plan administrator’s name BROOKHAVEN SURGERY CLINIC, P.A.
Plan administrator’s address 1036 BIGLANE DRIVE, BROOKHAVEN, MS, 39601
Administrator’s telephone number 6018351182

Signature of
Role Plan administrator
Date 2011-08-30
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-08-30
Name of individual signing MICHAEL PEAVEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/22/20100922133633P040001254648001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-03-01
Business code 621493
Sponsor’s telephone number 6018351182
Plan sponsor’s address 1036 BIGLANE DRIVE, BROOKHAVEN, MS, 39601

Plan administrator’s name and address
Administrator’s EIN 640822726
Plan administrator’s name BROOKHAVEN SURGERY CLINIC, P.A.
Plan administrator’s address 1036 BIGLANE DRIVE, BROOKHAVEN, MS, 39601
Administrator’s telephone number 6018351182

Signature of
Role Plan administrator
Date 2010-09-22
Name of individual signing MICHAEL T. PEAVEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-22
Name of individual signing MICHAEL T. PEAVEY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Charles Asa Reynolds MD Agent 1036 Biglane Drive, Brookhaven, MS 39601

Incorporator

Name Role Address
D Michael Cockrell Incorporator 600 Heritage Bldg, Congress At Capitol, Jackson, MS 39201

Director

Name Role Address
Charles Asa Reynolds Director 1036 Biglane Drive, Brookhaven, MS 39601

President

Name Role Address
Charles Asa Reynolds President 1036 Biglane Drive, Brookhaven, MS 39601

Secretary

Name Role Address
Charles Asa Reynolds Secretary 1036 Biglane Drive, Brookhaven, MS 39601

Treasurer

Name Role Address
Charles Asa Reynolds Treasurer 1036 Biglane Drive, Brookhaven, MS 39601

Filings

Type Status Filed Date Description
Annual Report Filed 2024-02-21 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2023-02-21 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Amendment Form Filed 2022-10-13 Amendment For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2022-02-02 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2021-02-01 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2020-02-05 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2019-02-26 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2018-04-04 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.
Amendment Form Filed 2018-01-18 Amendment For BROOKHAVEN SURGERY CLINIC, P.A.
Annual Report Filed 2017-03-15 Annual Report For BROOKHAVEN SURGERY CLINIC, P.A.

Related by officers

Charles Asa Reynolds MD

Cornerstone Property Management, LLC

D Michael Cockrell

AIR SUPPLY, INCORPORATED

Charles Asa Reynolds

CRICKETT TREE FARM, LLC

Related by address

1036 Biglane DriveBrookhaven, MS 39601

Cornerstone Properties

Date of last update: 22 Dec 2024

Sources: Mississippi Secretary of State

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