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  5. MISSION PRIMARY CARE CLINIC, PLLC

MISSION PRIMARY CARE CLINIC, PLLC

Company Details

Name: MISSION PRIMARY CARE CLINIC, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 04 Nov 1998 (26 years ago)
Business ID: 663109
ZIP code: 39180
County: Warren
State of Incorporation: MISSISSIPPI
Principal Office Address: 1901 Mission 66, 1901 Mission 66Vicksburg, MS 39180

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2023 640862084 2024-10-08 MISSION PRIMARY CARE CLINIC, PLLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2024-10-08
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-08
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2022 640862084 2023-06-02 MISSION PRIMARY CARE CLINIC, PLLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2023-06-02
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-06-02
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2021 640862084 2022-09-21 MISSION PRIMARY CARE CLINIC, PLLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2022-09-21
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2020 640862084 2021-10-08 MISSION PRIMARY CARE CLINIC, PLLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2021-10-08
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-08
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2019 640862084 2020-05-07 MISSION PRIMARY CARE CLINIC, PLLC 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2020-05-07
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-07
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2018 640862084 2019-09-19 MISSION PRIMARY CARE CLINIC, PLLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2019-09-19
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2017 640862084 2018-05-15 MISSION PRIMARY CARE CLINIC, PLLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2018-05-15
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-15
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2016 640862084 2017-07-12 MISSION PRIMARY CARE CLINIC, PLLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-12
Name of individual signing WILLIAM H FULCHER
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2015 640862084 2016-05-17 MISSION PRIMARY CARE CLINIC, PLLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2016-05-17
Name of individual signing WILLIAM H FULCHER JR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-17
Name of individual signing WILLILAM H FULCHER JR
Valid signature Filed with authorized/valid electronic signature
MISSION PRIMARY CARE CLINIC 401(K) PLAN 2014 640862084 2015-07-13 MISSION PRIMARY CARE CLINIC, PLLC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2015-07-13
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/22/20140722102838P040021090637001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2014-07-22
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-22
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/09/20130709150422P040296355187001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Signature of
Role Plan administrator
Date 2013-07-09
Name of individual signing WILLIAM H FULCHER JR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-09
Name of individual signing WILLIAM FULCHER JR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/20/20120920151651P040002845637001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Plan administrator’s name and address
Administrator’s EIN 640862084
Plan administrator’s name MISSION PRIMARY CARE CLINIC, PLLC
Plan administrator’s address 1901 MISSION 66, VICKSBURG, MS, 39180
Administrator’s telephone number 6016360097

Signature of
Role Plan administrator
Date 2012-09-20
Name of individual signing WILLIAM H FULCHER JR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/04/15/20110415083715P030200532576001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Plan administrator’s name and address
Administrator’s EIN 640862084
Plan administrator’s name MISSION PRIMARY CARE CLINIC, PLLC
Plan administrator’s address 1901 MISSION 66, VICKSBURG, MS, 39180
Administrator’s telephone number 6016360097

Signature of
Role Plan administrator
Date 2011-04-15
Name of individual signing WILLIAM H FULCHER JR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/06/20100706092339P030356519681001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Plan administrator’s name and address
Administrator’s EIN 640862084
Plan administrator’s name MISSION PRIMARY CARE CLINIC, PLLC
Plan administrator’s address 1901 MISSION 66, VICKSBURG, MS, 39180
Administrator’s telephone number 6016360097

Signature of
Role Plan administrator
Date 2010-07-06
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Plan administrator’s name and address
Administrator’s EIN 640862084
Plan administrator’s name MISSION PRIMARY CARE CLINIC, PLLC
Plan administrator’s address 1901 MISSION 66, VICKSBURG, MS, 39180
Administrator’s telephone number 6016360097

Signature of
Role Plan administrator
Date 2010-07-06
Name of individual signing WILLIAM FULCHER
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Plan administrator’s name and address
Administrator’s EIN 640862084
Plan administrator’s name MISSION PRIMARY CARE CLINIC, PLLC
Plan administrator’s address 1901 MISSION 66, VICKSBURG, MS, 39180
Administrator’s telephone number 6016360097

Signature of
Role Plan administrator
Date 2010-06-23
Name of individual signing BILL FULCHER
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-06-23
Name of individual signing BILL FULCHER
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Plan administrator’s name and address
Administrator’s EIN 640862084
Plan administrator’s name MISSION PRIMARY CARE CLINIC, PLLC
Plan administrator’s address 1901 MISSION 66, VICKSBURG, MS, 39180
Administrator’s telephone number 6016360097

Signature of
Role Plan administrator
Date 2010-06-23
Name of individual signing BILL FULCHER
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2000-05-01
Business code 621111
Sponsor’s telephone number 6016360097
Plan sponsor’s address 1901 MISSION 66, VICKSBURG, MS, 39180

Plan administrator’s name and address
Administrator’s EIN 640862084
Plan administrator’s name MISSION PRIMARY CARE CLINIC, PLLC
Plan administrator’s address 1901 MISSION 66, VICKSBURG, MS, 39180
Administrator’s telephone number 6016360097

Signature of
Role Plan administrator
Date 2010-06-23
Name of individual signing BILL FULCHER
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-06-23
Name of individual signing BILL FULCHER
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
R LEE GIFFIN Agent 1901 MISSION 66, VICKSBURG, MS 39180

Member

Name Role Address
R Lee Giffin Member 1901 MISSION 66, VICKSBURG, MS 39180

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2024-01-23 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2023-04-18 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2023-03-09 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2022-04-21 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2021-04-12 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2020-04-24 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2019-04-15 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2018-04-13 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2017-03-28 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC
Annual Report LLC Filed 2016-04-04 Annual Report For MISSION PRIMARY CARE CLINIC, PLLC

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
315304337 0419400 2011-09-08 1901 MISSION 66, VICKSBURG, MS, 39180
Inspection Type Planned
Scope Complete
Safety/Health Health
Close Conference 2011-09-08
Emphasis S: ELECTRICAL
Case Closed 2011-11-04

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100303 G02 I
Issuance Date 2011-09-26
Abatement Due Date 2011-10-04
Current Penalty 1000.0
Initial Penalty 1785.0
Nr Instances 1
Nr Exposed 2
Gravity 01
Citation ID 01002
Citaton Type Serious
Standard Cited 19101030 C01 IVB
Issuance Date 2011-09-26
Abatement Due Date 2011-10-27
Current Penalty 1000.0
Initial Penalty 1785.0
Nr Instances 1
Nr Exposed 32
Gravity 01
Citation ID 01003
Citaton Type Serious
Standard Cited 19101030 D02 IX
Issuance Date 2011-09-26
Abatement Due Date 2011-10-06
Current Penalty 1000.0
Initial Penalty 1785.0
Nr Instances 4
Nr Exposed 32
Gravity 01
Citation ID 01004
Citaton Type Serious
Standard Cited 19101030 G02 I
Issuance Date 2011-09-26
Abatement Due Date 2011-10-27
Current Penalty 1165.0
Initial Penalty 2975.0
Nr Instances 32
Nr Exposed 32
Gravity 05

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3151048504 2021-02-23 0470 PPS 1901 Mission 66, Vicksburg, MS, 39180-3711
Loan Status Date 2022-02-18
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 338570
Loan Approval Amount (current) 338570
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 R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Vicksburg, WARREN, MS, 39180-3711
Project Congressional District MS-02
Number of Employees 40
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 39848
Originating Lender Name Cadence Bank
Originating Lender Address TUPELO, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 341111.59
Forgiveness Paid Date 2021-12-01
6514377103 2020-04-14 0470 PPP 1901 MISSION 66, VICKSBURG, MS, 39180
Loan Status Date 2021-03-19
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 336007.5
Loan Approval Amount (current) 336007.5
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39848
Servicing Lender Name Cadence Bank
Servicing Lender Address 201 S Spring St, TUPELO, MS, 38804-4811
Rural or Urban Indicator R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address VICKSBURG, WARREN, MS, 39180-0003
Project Congressional District MS-02
Number of Employees 40
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 39848
Originating Lender Name Cadence Bank
Originating Lender Address TUPELO, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 338704.89
Forgiveness Paid Date 2021-02-04

U.S. Small Business Administration Profile

Status User ID Name of Firm Trade Name UEI Address
Active P3164284 MISSION PRIMARY CARE CLINIC, PLLC - RH6SKAX3DMW9 1901 MISSION 66, VICKSBURG, MS, 39180-3711
Capabilities Statement Link -
Phone Number 601-636-0097
Fax Number -
E-mail Address fulcher@missionprimary.com
WWW Page missionprimary.com
E-Commerce Website -
Contact Person WILLIAM FULCHER
County Code (3 digit) 149
Congressional District 02
Metropolitan Statistical Area -
CAGE Code 1UA78
Year Established 1995
Accepts Government Credit Card Yes
Legal Structure LLC
Ownership and Self-Certifications Self-Certified Small Disadvantaged Business
Business Development Servicing Office MISSISSIPPI DISTRICT OFFICE (SBA office code 0470)
Capabilities Narrative (none given)
Special Equipment/Materials (none given)
Business Type Percentages (none given)
Keywords (none given)
Quality Assurance Standards (none given)
Electronic Data Interchange capable -

SBA Federal Certifications
HUBZone Certified No
Women Owned Certified No
Women Owned Pending No
Economically Disadvantaged Women Owned Certified No
Economically Disadvantaged Women Owned Pending No
Veteran-Owned Small Business Certified No
Veteran-Owned Small Business Joint Venture No
Service-Disabled Veteran-Owned Small Business Certified No
Service-Disabled Veteran-Owned Small Business Joint Venture No

Bonding Levels
Description Construction Bonding Level (per contract)
Level (none given)
Description Construction Bonding Level (aggregate)
Level (none given)
Description Service Bonding Level (per contract)
Level (none given)
Description Service Bonding Level (aggregate)
Level (none given)

NAICS Codes with Size Determinations by NAICS
Primary Yes
Code 621111
NAICS Code's Description Offices of Physicians (except Mental Health Specialists)
Buy Green Yes

Export Profile (Trade Mission Online)
Exporter Firm hasn't answered this question yet
Export Business Activities (none given)
Exporting to (none given)
Desired Export Business Relationships (none given)
Description of Export Objective(s) (none given)

Related by officers

R LEE GIFFIN

MISSION PRIMARY CARE REAL ESTATE, LLC

R Lee Giffin

MISSION PRIMARY CARE REAL ESTATE, LLC

Related by address

1901 Mission 66, 1901 Mission 66Vicksburg, MS 39180

R.L.G., M.D., P.A. MISSION PRIMARY CARE REAL ESTATE, LLC Joseph L. Wilson MD Inc. Denesia Y Giffin PLLC Medically Heard, LLC

Date of last update: 17 Mar 2025

Sources: Mississippi Secretary of State

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