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CLAIBORNE COUNTY FAMILY HEALTH CENTER INC.

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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

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

National Provider Identifier

NPI Number:
1194968982

Authorized Person:

Name:
CONEY L JOHNSON
Role:
CHIEF EXECUTIVE OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary:
Yes

Contacts:

Fax:
6014373051

Form 5500 Series

Employer Identification Number (EIN):
640651149
Plan Year:
2012
Number Of Participants:
25
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
25
Sponsors Telephone Number:

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

Date:
2020-06-10
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
396142.92
Total Face Value Of Loan:
396142.92
Date:
2008-05-26
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
HEALTH CENTER CLUSTER
Obligated Amount:
11496302.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Tax Exempt

Employer Identification Number (EIN) :
64-0651149
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)
Ruling Date:
1983-03
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Paycheck Protection Program

Date Approved:
2020-06-10
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
396142.92
Current Approval Amount:
396142.92
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
398442.75

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Date of last update: 22 Apr 2025

Sources: Mississippi Secretary of State