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CLAIBORNE COUNTY FAMILY HEALTH CENTER INC.

Company Details

Name: CLAIBORNE COUNTY FAMILY HEALTH CENTER INC.
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 14 Aug 1981 (44 years ago)
Business ID: 602902
ZIP code: 39150
County: Claiborne
State of Incorporation: MISSISSIPPI
Principal Office Address: 2045 Hwy 61 NorthPortGibson, MS 39150

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CLAIBORNE COUNTY FAMILY HEALTH CENTER RETIREMENT PLAN 2012 640651149 2014-04-15 CLAIBORNE COUNTY FAMILY HEALTH CENTER 25
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Three-digit plan number (PN) 003
Effective date of plan 1994-06-01
Business code 621111
Sponsor’s telephone number 6014373050
Plan sponsor’s address 2045 HIGHWAY 61 NORTH, PORT GIBSON, MS, 39150

Signature of

Role Plan administrator
Date 2014-04-15
Name of individual signing JAMES E. OLIVER
Valid signature Filed with authorized/valid electronic signature
CLAIBORNE COUNTY FAMILY HEALTH CENTER MONEY PURCHASE PLAN 2012 640651149 2014-04-15 CLAIBORNE COUNTY FAMILY HEALTH CENTER 25
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Three-digit plan number (PN) 002
Effective date of plan 1992-08-01
Business code 621111
Sponsor’s telephone number 6014373050
Plan sponsor’s address 2045 HIGHWAY 61 NORTH, PORT GIBSON, MS, 39150

Signature of

Role Plan administrator
Date 2014-04-15
Name of individual signing JAMES E. OLIVER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LaDonna B Davis Agent 2045 Highway 61 North, 2045 Hwy 61 North, Port Gibson, MS 39150

Incorporator

Name Role Address
ELONZO MCCLORINE Incorporator HIGHWAY 547, PATTISON, MS
EVAN DOSS JR Incorporator 911 CHINQUEPIN ST, PORT GIBSON, MS
PATRICIA CROSBY Incorporator HIGHWAY 552, LORMAN, MS
WILLIAM MATT ROSS Incorporator HIGHWAY 547, PORT GIBSON, MS

President

Name Role Address
Kenneth R Davis President 306 Cedar Street, Port Gibson, MS 39150

Vice President

Name Role Address
Delores Barnes Vice President Post Office Box 88, Port Gibson, MS 39150

Treasurer

Name Role Address
Rosevelt Harried Treasurer 1054 Tommy Dotson Road, Port Gibson, MS 39150

Secretary

Name Role Address
Cinder Bailey Secretary Post Office Box 293, Port Gibson, MS 39150

Chief Executive Officer

Name Role Address
James E Oliver Chief Executive Officer 2045 Hwy 61 North, PortGibson, MS 39150

Assistant Secretary

Name Role Address
Marie Clark Assistant Secretary Post Office Box 592, Port Gibson, MS 39150

Filings

Type Status Filed Date Description
Non-Profit Status Report Filed 2020-12-15 Status Report For CLAIBORNE COUNTY FAMILY HEALTH CENTER INC.
Amendment Form Filed 1993-12-15 Amendment
Reinstatement Filed 1990-11-21 Reinstatement
Formation Form Filed 1990-11-21 Formation
See File Filed 1982-11-17 See File
Name Reservation Form Filed 1981-08-14 Name Reservation

USAspending Awards. Financial Assistance

FAIN Awarding Agency Assistance Listings Start Date End Date Description
H80CS00482 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 2010-05-31 HEALTH CENTER CLUSTER
Recipient CLAIBORNE COUNTY FAMILY HEALTH CENTER
Recipient Name Raw CLAIBORNE COUNTY FAMILY HEALTH CENTER
Recipient DUNS 101880917
Recipient Address POST OFFICE BOX 741, PORT GIBSON, CLAIBORNE, MISSISSIPPI, 39150
Obligated Amount 11496302.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
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Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
64-0651149 Corporation Unconditional Exemption PO BOX 741, PORT GIBSON, MS, 39150-0741 1983-03
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, Educational Organization, Local Association of Employees, Agricultural Organization, Horticultural Organization, Board of Trade, Business League, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Voluntary Employees' Beneficiary Association (Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Mutual Ditch or Irrigation Co., Burial Association, Cemetery Company, Credit Union, Other Mutual Corp. or Assoc., 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 Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-06
Asset 1,000,000 to 4,999,999
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 Jun
Asset Amount 1257950
Income Amount 4128514
Form 990 Revenue Amount 4128514
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 CLAIBORNE COUNTY FAMILY HEALTH CENTER INC
EIN 64-0651149
Tax Period 202206
Filing Type E
Return Type 990
File View File
Organization Name CLAIBORNE COUNTY FAMILY HEALTH CENTER INC
EIN 64-0651149
Tax Period 201906
Filing Type E
Return Type 990
File View File
Organization Name CLAIBORNE COUNTY FAMILY HEALTH CENTER INC
EIN 64-0651149
Tax Period 201806
Filing Type E
Return Type 990
File View File
Organization Name CLAIBORNE COUNTY FAMILY HEALTH CENTER INC
EIN 64-0651149
Tax Period 201706
Filing Type E
Return Type 990
File View File
Organization Name CLAIBORNE COUNTY FAMILY HEALTH CENTER INC
EIN 64-0651149
Tax Period 201606
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
1382807901 2020-06-10 0470 PPP 2045 HIGHWAY 61N, PORT GIBSON, MS, 39150-4262
Loan Status Date 2021-02-20
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 396142.92
Loan Approval Amount (current) 396142.92
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39691
Servicing Lender Name RiverHills Bank
Servicing Lender Address 1400 Hwy 61 N, VICKSBURG, MS, 39183-3413
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address PORT GIBSON, CLAIBORNE, MS, 39150-4262
Project Congressional District MS-02
Number of Employees 29
NAICS code 621498
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 39691
Originating Lender Name RiverHills Bank
Originating Lender Address VICKSBURG, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 398442.75
Forgiveness Paid Date 2021-01-07

Date of last update: 15 Mar 2025

Sources: Mississippi Secretary of State