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  5. JACKSON MEDICAL MALL FOUNDATION

JACKSON MEDICAL MALL FOUNDATION

Company Details

Name: JACKSON MEDICAL MALL FOUNDATION
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 16 Aug 1995 (30 years ago)
Business ID: 621237
ZIP code: 39225
County: Hinds
State of Incorporation: MISSISSIPPI
Principal Office Address: 111 East Capitol Street Suite 600;P O Box 23066Jackson, MS 39225

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
5493005HZ0GHTUEACK71 621237 US-MS GENERAL ACTIVE 1995-08-16

Addresses
Legal C/O Davidson, Chad A., 4270 I-55 North (39211);PO Box 16114, Jackson, US-MS, US, 39236
Headquarters 350 West Woodrow Wilson, Suite 101, Jackson, US-MS, US, 39213

Registration details
Registration Date 2017-01-11
Last Update 2023-09-12
Status LAPSED
Next Renewal 2023-09-12
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 621237

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JACKSON MEDICAL MALL FOUNDATION RETIREMENT PLAN 2023 640865274 2024-09-18 JACKSON MEDICAL MALL FOUNDATION 148
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 6019828467
Plan sponsor’s address 350 WEST WOODROW WILSON #107, JACKSON, MS, 39213

Signature of
Role Plan administrator
Date 2024-09-18
Name of individual signing LORI GREER
Valid signature Filed with authorized/valid electronic signature
JACKSON MEDICAL MALL FOUNDATION 403(B) PLAN 2017 640865274 2018-07-13 JACKSON MEDICAL MALL FOUNDATION 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 6207938473
Plan sponsor’s address P.O. BOX 11508, JACKSON, MS, 392831508

Signature of
Role Plan administrator
Date 2018-07-13
Name of individual signing LORI GREER
Valid signature Filed with authorized/valid electronic signature
JACKSON MEDICAL MALL FOUNDATION 403(B) PLAN 2016 640865274 2017-05-03 JACKSON MEDICAL MALL FOUNDATION 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 6207938473
Plan sponsor’s address P.O. BOX 11508, JACKSON, MS, 392831508

Signature of
Role Plan administrator
Date 2017-05-03
Name of individual signing LORI GREER
Valid signature Filed with authorized/valid electronic signature
JACKSON MEDICAL MALL FOUNDATION 403(B) PLAN 2015 640865274 2016-07-11 JACKSON MEDICAL MALL FOUNDATION 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 6207938473
Plan sponsor’s address P.O. BOX 11508, JACKSON, MS, 392831508
JACKSON MEDICAL MALL FOUNDATION 403(B) PLAN 2014 640865274 2015-06-23 JACKSON MEDICAL MALL FOUNDATION 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 6207938473
Plan sponsor’s address P.O. BOX 11508, JACKSON, MS, 392831508
JACKSON MEDICAL MALL FOUNDATION 403(B) PLAN 2013 640865274 2015-06-23 JACKSON MEDICAL MALL FOUNDATION 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 6207938473
Plan sponsor’s address P.O. BOX 11508, JACKSON, MS, 392831508
JACKSON MEDICAL MALL FOUNDATION 403(B) PLAN 2012 640865274 2015-06-23 JACKSON MEDICAL MALL FOUNDATION 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 6207938473
Plan sponsor’s address P.O. BOX 11508, JACKSON, MS, 392831508

Signature of
Role Plan administrator
Date 2015-06-18
Name of individual signing LORI GREER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Davidson, Chad A. Agent 4270 I-55 North (39211);PO Box 16114, Jackson, MS 39236

Incorporator

Name Role Address
AARON SHIRLEY, M.D. Incorporator 4433 MEDGAR EVERS BLVD, JACKSON, MS 39213

Filings

Type Status Filed Date Description
Amendment Form Filed 2015-12-22 Amendment For JACKSON MEDICAL MALL FOUNDATION
Amendment Form Filed 2011-02-18 Amendment
Amendment Form Filed 2010-08-20 Amendment
Amendment Form Filed 2009-07-15 Amendment
Amendment Form Filed 2004-04-02 Amendment
Amendment Form Filed 1996-12-05 Amendment
Name Reservation Form Filed 1995-08-16 Name Reservation

USAspending Awards. Contracts

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
DELIVERY ORDER AWARD GS04B4416108085 2008-01-01 2008-09-30 2008-09-30
Unique Award Key CONT_AWD_GS04B4416108085_4740_GS04B44161_4740
Awarding Agency General Services Administration
Link View Page

Award Amounts
Obligated Amount 120.82
Current Award Amount 120.82
Potential Award Amount 120.82

Description
Title LEASE
NAICS Code 531120: LESSORS OF NONRESIDENTIAL BUILDINGS (EXCEPT MINIWAREHOUSES)
Product and Service Codes X111: LEASE/RENTAL OF OFFICE BUILDINGS

Recipient Details
Recipient JACKSON MEDICAL MALL FOUNDATION
UEI ZKMBHH6NMWC1
Recipient Address 350 W WOODROW WILSON AVE STE 615, JACKSON, HINDS, MISSISSIPPI, 392137651, UNITED STATES
DELIVERY ORDER AWARD GS04B4416108023 2008-01-01 2008-09-30 2008-09-30
Unique Award Key CONT_AWD_GS04B4416108023_4740_GS04B44161_4740
Awarding Agency General Services Administration
Link View Page

Award Amounts
Obligated Amount 120.82
Current Award Amount 120.82
Potential Award Amount 120.82

Description
Title LEASE
NAICS Code 531120: LESSORS OF NONRESIDENTIAL BUILDINGS (EXCEPT MINIWAREHOUSES)
Product and Service Codes X111: LEASE/RENTAL OF OFFICE BUILDINGS

Recipient Details
Recipient JACKSON MEDICAL MALL FOUNDATION
UEI ZKMBHH6NMWC1
Recipient Address 350 W WOODROW WILSON AVE STE 615, JACKSON, HINDS, MISSISSIPPI, 392137651, UNITED STATES
DELIVERY ORDER AWARD GS04B4416108052 2008-01-01 2008-09-30 2008-09-30
Unique Award Key CONT_AWD_GS04B4416108052_4740_GS04B44161_4740
Awarding Agency General Services Administration
Link View Page

Award Amounts
Obligated Amount 120.82
Current Award Amount 120.82
Potential Award Amount 120.82

Description
Title LEASE
NAICS Code 531120: LESSORS OF NONRESIDENTIAL BUILDINGS (EXCEPT MINIWAREHOUSES)
Product and Service Codes X111: LEASE/RENTAL OF OFFICE BUILDINGS

Recipient Details
Recipient JACKSON MEDICAL MALL FOUNDATION
UEI ZKMBHH6NMWC1
Recipient Address 350 W WOODROW WILSON AVE STE 615, JACKSON, HINDS, MISSISSIPPI, 392137651, UNITED STATES
DELIVERY ORDER AWARD GS04B4416107296 2007-10-01 2008-09-30 2008-09-30
Unique Award Key CONT_AWD_GS04B4416107296_4740_GS04B44161_4740
Awarding Agency General Services Administration
Link View Page

Award Amounts
Obligated Amount 120.82
Current Award Amount 120.82
Potential Award Amount 120.82

Description
Title LEASE
NAICS Code 531120: LESSORS OF NONRESIDENTIAL BUILDINGS (EXCEPT MINIWAREHOUSES)
Product and Service Codes X111: LEASE/RENTAL OF OFFICE BUILDINGS

Recipient Details
Recipient JACKSON MEDICAL MALL FOUNDATION
UEI ZKMBHH6NMWC1
Recipient Address 350 W WOODROW WILSON AVE STE 615, JACKSON, HINDS, MISSISSIPPI, 392137651, UNITED STATES
DELIVERY ORDER AWARD GS04B4416107332 2007-10-01 2008-09-30 2008-09-30
Unique Award Key CONT_AWD_GS04B4416107332_4740_GS04B44161_4740
Awarding Agency General Services Administration
Link View Page

Award Amounts
Obligated Amount 120.82
Current Award Amount 120.82
Potential Award Amount 120.82

Description
Title LEASE
NAICS Code 531120: LESSORS OF NONRESIDENTIAL BUILDINGS (EXCEPT MINIWAREHOUSES)
Product and Service Codes X111: LEASE/RENTAL OF OFFICE BUILDINGS

Recipient Details
Recipient JACKSON MEDICAL MALL FOUNDATION
UEI ZKMBHH6NMWC1
Recipient Address 350 W WOODROW WILSON AVE STE 615, JACKSON, HINDS, MISSISSIPPI, 392137651, UNITED STATES
DELIVERY ORDER AWARD GS04B4416107356 2007-10-01 2008-09-30 2008-09-30
Unique Award Key CONT_AWD_GS04B4416107356_4740_GS04B44161_4740
Awarding Agency General Services Administration
Link View Page

Award Amounts
Obligated Amount 120.82
Current Award Amount 120.82
Potential Award Amount 120.82

Description
Title LEASE
NAICS Code 531120: LESSORS OF NONRESIDENTIAL BUILDINGS (EXCEPT MINIWAREHOUSES)
Product and Service Codes X111: LEASE/RENTAL OF OFFICE BUILDINGS

Recipient Details
Recipient JACKSON MEDICAL MALL FOUNDATION
UEI ZKMBHH6NMWC1
Recipient Address 350 W WOODROW WILSON AVE STE 615, JACKSON, HINDS, MISSISSIPPI, 392137651, UNITED STATES

USAspending Awards. Financial Assistance

FAIN Awarding Agency Assistance Listings Start Date End Date Description
STC12010GR02 Department of State 19.021 - INVESTING IN PEOPLE IN THE MIDDLE EAST AND NORTH AFRICA 2010-09-01 2011-06-30 TO FUND TRAVEL OF SIX IRANIAN HEALTH CARE EXPERTS WORKING WITH THE OXFORD INTL DEVELOPMENY GROUP TO DEVELOPE A MODEL FOR SUCCESSFUL DELIVERY OF THE
Recipient JACKSON MEDICAL MALL FOUNDATION
Recipient Name Raw JACKSON MEDICAL MALL FOUNDATION
Recipient UEI ZKMBHH6NMWC1
Recipient DUNS 176172005
Recipient Address JACKSON MS 39283, P.O.BOX 11508, JACKSON COUNTY (JACKS, JACKSON, MISSISSIPPI, 39213-7627
Obligated Amount 47373.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
2009D1BX0290 Department of Justice 16.753 - CONGRESSIONALLY RECOMMENDED AWARDS 2009-09-01 2011-08-31 THE NEW FOCUS FOR YOUTH INTERVENTION PROGRAM
Recipient JACKSON MEDICAL MALL FOUNDATION
Recipient Name Raw JACKSON MEDICAL MALL FOUNDATION
Recipient Address 350 W. WOODROW WILSON AVENUE, SUITE 201, PRESIDENTIAL HILLS, HINDS, MISSISSIPPI, 39213-7673, UNITED STATES
Obligated Amount 400000.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
R03HL096130 Department of Health and Human Services 93.837 - CARDIOVASCULAR DISEASES RESEARCH 2008-09-30 2010-06-30 PARTNERS IN RESEARCH
Recipient JACKSON MEDICAL MALL FOUNDATION
Recipient Name Raw JACKSON MEDICAL MALL FOUNDATION
Recipient UEI R9JTHJM7H6U4
Recipient DUNS 159765510
Recipient Address 350 WOODROW WILSON, JACKSON, HINDS, MISSISSIPPI, 39213
Obligated Amount 60000.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
C76HF09470 Department of Health and Human Services 93.887 - HEALTH CARE AND OTHER FACILITIES 2008-09-01 2009-08-31 HEALTH CARE AND OTHER FACILITIES
Recipient JACKSON MEDICAL MALL FOUNDATION
Recipient Name Raw JACKSON MEDICAL MALL FOUNDATION
Recipient UEI R9JTHJM7H6U4
Recipient DUNS 159765510
Recipient Address 350 WOODROW WILSON, JACKSON, HINDS, MISSISSIPPI, 39213
Obligated Amount 142015.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
B08SPMS0620 Department of Housing and Urban Development 14.251 - ECONOMIC DEVELOPMENT INITIATIVE-SPECIAL PROJECT, NEIGHBORHOOD INITIATIVE AND MISCELLANEOUS GRANTS 2007-10-01 2008-09-30 EDI SPECIAL PROJECTS
Recipient JACKSON MEDICAL MALL FOUNDATION
Recipient Name Raw JACKSON MEDICAL MALL FOUNDATION
Recipient Address 350 WEST WOODROW WILSON BLVD., JACKSON, HINDS, MISSISSIPPI, 39213
Obligated Amount 392000.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
64-0865274 Corporation Unconditional Exemption 350 W WOODROW WILSON AVE STE 101, JACKSON, MS, 39213-7651 1996-03
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, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, 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 Organizations operated solely for the benefit of and in conjunction with organizations described in 10 through 16 above 509(a)(3)
Tax Period 2023-06
Asset 50,000,000 to greater
Income 10,000,000 to 49,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Jun
Asset Amount 67804856
Income Amount 18766630
Form 990 Revenue Amount 18766630
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 supporting organization, unspecified type. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name JACKSON MEDICAL MALL FOUNDATION
EIN 64-0865274
Tax Period 202306
Filing Type E
Return Type 990
File View File
Organization Name JACKSON MEDICAL MALL FOUNDATION
EIN 64-0865274
Tax Period 202206
Filing Type E
Return Type 990
File View File
Organization Name JACKSON MEDICAL MALL FOUNDATION
EIN 64-0865274
Tax Period 202006
Filing Type E
Return Type 990
File View File
Organization Name JACKSON MEDICAL MALL FOUNDATION
EIN 64-0865274
Tax Period 201906
Filing Type E
Return Type 990
File View File
Organization Name JACKSON MEDICAL MALL FOUNDATION
EIN 64-0865274
Tax Period 201806
Filing Type E
Return Type 990
File View File
Organization Name JACKSON MEDICAL MALL FOUNDATION
EIN 64-0865274
Tax Period 201706
Filing Type E
Return Type 990
File View File
Organization Name JACKSON MEDICAL MALL FOUNDATION
EIN 64-0865274
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
9581408502 2021-03-12 0470 PPS 350 W Woodrow Wilson Ave, Jackson, MS, 39213-7681
Loan Status Date 2022-02-19
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 840160
Loan Approval Amount (current) 840160
Undisbursed Amount 0
Franchise Name -
Lender Location ID 188567
Servicing Lender Name Loan Source Incorporated
Servicing Lender Address 353 East 83rd Street Suite 3H, NEW YORK, NY, 10028
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Jackson, HINDS, MS, 39213-7681
Project Congressional District MS-02
Number of Employees 130
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 39334
Originating Lender Name Trustmark National Bank
Originating Lender Address JACKSON, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 844947.76
Forgiveness Paid Date 2021-10-19
7259327106 2020-04-14 0470 PPP 350 W. WOODROW WILSON AVE, JACKSON, MS, 39213-7651
Loan Status Date 2021-01-22
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 791180
Loan Approval Amount (current) 791180
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39334
Servicing Lender Name Trustmark National Bank
Servicing Lender Address 248 E Capitol St, JACKSON, MS, 39201-2503
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address JACKSON, HINDS, MS, 39213-7651
Project Congressional District MS-02
Number of Employees 130
NAICS code 813211
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 39334
Originating Lender Name Trustmark National Bank
Originating Lender Address JACKSON, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 795509.51
Forgiveness Paid Date 2020-11-12

Related by officers

Davidson, Chad A.

E AND E SPORTS CARS, INC. S and W SPORTS CARS, INC. SH Martin Enterprises, LLC Jackson Medical Mall Community Development Corporation Grenada Community Foundation JSISR, LLC

AARON SHIRLEY, M.D.

PRIMARY CARE NETWORK OF CENTRAL MISSISSIPPI, INC.

Related by address

No related companies by address

Date of last update: 16 Mar 2025

Sources: Mississippi Secretary of State

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