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  5. Mississippi Retina Associates, PLLC

Mississippi Retina Associates, PLLC

Company Details

Name: Mississippi Retina Associates, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 29 Mar 1995 (30 years ago)
Business ID: 616554
ZIP code: 39202
County: Hinds
State of Incorporation: MISSISSIPPI
Principal Office Address: 1200 North State Street, Suite 300Jackson, MS 39202
Historical names: MISSISSIPPI RETINA ASSOCIATES, P.A.

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MISSISSIPPI RETINA ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2022 640860086 2023-07-05 MISSISSIPPI RETINA ASSOCIATES, P.A. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2023-07-05
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. CASH BALANCE PLAN 2021 640860086 2022-02-18 MISSISSIPPI RETINA ASSOCIATES, P.A. 48
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2022-02-18
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2021 640860086 2022-07-07 MISSISSIPPI RETINA ASSOCIATES, P.A. 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2022-07-07
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. CASH BALANCE PLAN 2020 640860086 2021-07-07 MISSISSIPPI RETINA ASSOCIATES, P.A. 56
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2021-07-07
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2020 640860086 2021-07-07 MISSISSIPPI RETINA ASSOCIATES, P.A. 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2021-07-07
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2019 640860086 2020-06-03 MISSISSIPPI RETINA ASSOCIATES, P.A. 56
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2020-06-03
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. CASH BALANCE PLAN 2019 640860086 2020-09-16 MISSISSIPPI RETINA ASSOCIATES, P.A. 56
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2020-09-16
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. CASH BALANCE PLAN 2018 640860086 2019-10-01 MISSISSIPPI RETINA ASSOCIATES, P.A. 38
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2019-10-01
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2018 640860086 2019-07-18 MISSISSIPPI RETINA ASSOCIATES, P.A. 57
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2019-07-18
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
MISSISSIPPI RETINA ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2017 640860086 2018-07-05 MISSISSIPPI RETINA ASSOCIATES, P.A. 56
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2018-07-05
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/09/28/20180928133202P030224693073001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2018-09-28
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/10/11/20171011164536P030208764273001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2017-10-11
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-11
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2017-10-10
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-10
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2017-10-11
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-11
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/10/11/20171011114434P040195133287001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2017-10-11
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-11
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/07/26/20160726104358P030025537663001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2016-07-26
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-26
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/08/26/20150826102958P030026217287001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2015-08-26
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-08-26
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/03/17/20140317175613P030298292385001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1200 NORTH STATE STREET, SUITE 300, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2014-03-17
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-03-17
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/04/26/20130426123100P040190535731001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1190 NORTH STATE STREET, SUITE 500, JACKSON, MS, 39202

Signature of
Role Plan administrator
Date 2013-04-26
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-26
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/11/20120711122335P030001047618001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1190 NORTH STATE STREET, SUITE 500, JACKSON, MS, 39202

Plan administrator’s name and address
Administrator’s EIN 640860086
Plan administrator’s name MISSISSIPPI RETINA ASSOCIATES, P.A.
Plan administrator’s address 1190 NORTH STATE STREET, SUITE 500, JACKSON, MS, 39202
Administrator’s telephone number 6019814091

Signature of
Role Plan administrator
Date 2012-07-11
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-11
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/09/20110609153029P040012684246001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1190 NORTH SATE STREET, SUITE 500, JACKSON, MS, 39202

Plan administrator’s name and address
Administrator’s EIN 640860086
Plan administrator’s name MISSISSIPPI RETINA ASSOCIATES, P.A.
Plan administrator’s address 1190 NORTH SATE STREET, SUITE 500, JACKSON, MS, 39202
Administrator’s telephone number 6019814091

Signature of
Role Plan administrator
Date 2011-06-09
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-09
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/08/17/20100817134200P070001769283001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 621111
Sponsor’s telephone number 6019814091
Plan sponsor’s address 1190 NORTH SATE STREET, SUITE 500, JACKSON, MS, 39202

Plan administrator’s name and address
Administrator’s EIN 640860086
Plan administrator’s name MISSISSIPPI RETINA ASSOCIATES, P.A.
Plan administrator’s address 1190 NORTH SATE STREET, SUITE 500, JACKSON, MS, 39202
Administrator’s telephone number 6019814091

Signature of
Role Plan administrator
Date 2010-08-17
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-17
Name of individual signing SHELLY MCCLELLAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
C. T. CORPORATION SYSTEM Agent 645 LAKELAND EAST DRIVE STE 101, FLOWOOD, MS 39232

Member

Name Role Address
Michael J. Borne Member 1200 North State Street, Suite 300, Jackson, MS 39202

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2024-02-16 Annual Report For Mississippi Retina Associates, PLLC
Amendment Form Filed 2023-05-02 Amendment For Mississippi Retina Associates, PLLC
Annual Report LLC Filed 2023-01-12 Annual Report For Mississippi Retina Associates, PLLC
Annual Report LLC Filed 2022-04-14 Annual Report For Mississippi Retina Associates, PLLC
Business Conversion Filed 2021-12-03 Business Conversion For MISSISSIPPI RETINA ASSOCIATES, P.A.
Amendment Form Filed 2021-08-03 Amendment For MISSISSIPPI RETINA ASSOCIATES, P.A.
Annual Report Filed 2021-02-01 Annual Report For MISSISSIPPI RETINA ASSOCIATES, P.A.
Annual Report Filed 2020-01-14 Annual Report For MISSISSIPPI RETINA ASSOCIATES, P.A.
Annual Report Filed 2019-02-25 Annual Report For MISSISSIPPI RETINA ASSOCIATES, P.A.
Annual Report Filed 2018-04-04 Annual Report For MISSISSIPPI RETINA ASSOCIATES, P.A.

Related by officers

C. T. CORPORATION SYSTEM

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Michael J. Borne

Retina ASC Holdings, LLC

Related by address

1200 North State Street, Suite 300Jackson, MS 39202

MBFH, LLC James D. Fly, M.D., P.A. James J. Brown, M.D., P.A. Mississippi Retina MSO, LLC Magnolia Retina Holdings, LLC Retina ASC Holdings, LLC

Date of last update: 23 Dec 2024

Sources: Mississippi Secretary of State

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