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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 (29 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

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: 23 Dec 2024

Sources: Mississippi Secretary of State

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