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  5. KING'S DAUGHTERS MEDICAL CENTER

KING'S DAUGHTERS MEDICAL CENTER

Company Details

Name: KING'S DAUGHTERS MEDICAL CENTER
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 14 Oct 1914 (110 years ago)
Business ID: 665588
ZIP code: 39601
County: Lincoln
State of Incorporation: MISSISSIPPI
Principal Office Address: 427 Highway 51 NorthBrookhaven, MS 39601

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KDMC GROUP LIFE 2023 640333594 2024-08-07 KING'S DAUGHTERS MEDICAL CENTER 314
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018359488
Plan sponsor’s mailing address P.O. BOX 948, 437 HIGHWAY 51 N., BROOKHAVEN, MS, 39601
Plan sponsor’s address P.O. BOX 948, 437 HIGHWAY 51 N., BROOKHAVEN, MS, 39601

Plan administrator’s name and address
Administrator’s EIN 640333594
Plan administrator’s name KING'S DAUGHTERS MEDICAL CENTER
Plan administrator’s address P.O. BOX 948, 437 HIGHWAY 51 N., BROOKHAVE, MS, 39601
Administrator’s telephone number 6018359488

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2024-08-07
Name of individual signing ADAM MOORE
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER LONG TERM DISABILITY 2021 640333594 2024-08-07 KING'S DAUGHTERS MEDICAL CENTER 509
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018359488
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 437 HIGHWAY 51 N., BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2024-08-07
Name of individual signing ADAM MOORE
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER GROUP LIFE 2021 640333584 2022-06-01 KING'S DAUGHTERS MEDICAL CENTER 475
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2014-01-01
Business code 622000
Sponsor’s telephone number 6018359488
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HWY 51 N, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 782

Signature of
Role Plan administrator
Date 2022-06-01
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-01
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER LONG TERM DISABILITY 2021 640333594 2022-06-01 KING'S DAUGHTERS MEDICAL CENTER 509
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018359488
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HWY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 510

Signature of
Role Plan administrator
Date 2022-06-01
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-01
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER LONG TERM DISABILITY 2020 640333594 2021-10-25 KING'S DAUGHTERS MEDICAL CENTER 535
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HWY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 509

Signature of
Role Plan administrator
Date 2021-10-25
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER GROUP LIFE 2020 640333584 2021-10-25 KING'S DAUGHTERS MEDICAL CENTER 487
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2014-01-01
Business code 622000
Sponsor’s telephone number 6018359488
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HWY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 475

Signature of
Role Plan administrator
Date 2021-07-26
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-26
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER LONG TERM DISABILITY 2019 640333594 2021-10-25 KING'S DAUGHTERS MEDICAL CENTER 519
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HWY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 535

Signature of
Role Plan administrator
Date 2021-07-27
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-27
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER GROUP LIFE 2019 640333584 2021-10-25 KING'S DAUGHTERS MEDICAL CENTER 484
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2014-01-01
Business code 622000
Sponsor’s telephone number 6018359488
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HWY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 487

Signature of
Role Plan administrator
Date 2021-07-27
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-27
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER LONG TERM DISABILITY 2018 640333594 2019-07-17 KING'S DAUGHTERS MEDICAL CENTER 530
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HWY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 519

Signature of
Role Plan administrator
Date 2019-07-16
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-16
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
KING'S DAUGHTERS MEDICAL CENTER LONG TERM DISABILITY 2017 640333594 2018-07-24 KING'S DAUGHTERS MEDICAL CENTER 531
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HIGHWAY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 530

Signature of
Role Plan administrator
Date 2018-06-29
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-24
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/07/31/20180731082208P040092457879001.pdf
Three-digit plan number (PN) 502
Effective date of plan 2014-01-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HIGHWAY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 484

Signature of
Role Plan administrator
Date 2018-06-29
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-24
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/07/25/20170725164502P030051513453001.pdf
Three-digit plan number (PN) 502
Effective date of plan 2014-01-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HIGHWAY 51 N, BROOKHAVEN, MS, 396012350

Number of participants as of the end of the plan year
Active participants 496

Signature of
Role Plan administrator
Date 2017-07-23
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-25
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/07/25/20170725164438P030051513037001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address PO BOX 948, BROOKHAVEN, MS, 396020948
Plan sponsor’s address 427 HIGHWAY 51 N, BROOKHAVEN, MS, 39601

Number of participants as of the end of the plan year
Active participants 531

Signature of
Role Plan administrator
Date 2017-07-23
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-25
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/07/29/20160729155341P030060713681001.pdf
Three-digit plan number (PN) 502
Effective date of plan 2014-01-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address PO BOX 948, 427 HIGHWAY 51 N, BROOKHAVEN, MS, 396012350
Plan sponsor’s address PO BOX 948, 427 HIGHWAY 51 N, BROOKHAVEN, MS, 396012350

Number of participants as of the end of the plan year
Active participants 465

Signature of
Role Plan administrator
Date 2016-07-29
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-29
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/07/27/20160727221245P040053298929001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HIGHWAY 51 N, BROOKHAVEN, MS, 396012350
Plan sponsor’s address P.O. BOX 948, 427 HIGHWAY 51 N, BROOKHAVEN, MS, 396012350

Number of participants as of the end of the plan year
Active participants 429

Signature of
Role Plan administrator
Date 2016-07-27
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-27
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/07/16/20150716181245P030117060753001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 503

Signature of
Role Plan administrator
Date 2015-07-16
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-16
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/07/16/20150716172750P040117774353001.pdf
Three-digit plan number (PN) 502
Effective date of plan 2014-01-01
Business code 622000
Sponsor’s telephone number 6018335313
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 434

Signature of
Role Plan administrator
Date 2015-07-16
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 507
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39602
Plan sponsor’s address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 230

Signature of
Role Plan administrator
Date 2014-06-19
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-11
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/19/20140619151139P040401983523001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 520

Signature of
Role Plan administrator
Date 2014-06-19
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-19
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 502
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 320

Signature of
Role Plan administrator
Date 2014-06-18
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/02/20130702083224P030278978659001.pdf
Three-digit plan number (PN) 502
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 314

Signature of
Role Plan administrator
Date 2013-06-29
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-01
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/06/29/20130629114645P030099559445001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 526

Signature of
Role Plan administrator
Date 2013-06-29
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-29
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/03/20130703113717P040101856293001.pdf
Three-digit plan number (PN) 507
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018359381
Plan sponsor’s mailing address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39602
Plan sponsor’s address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39602

Number of participants as of the end of the plan year
Active participants 245

Signature of
Role Plan administrator
Date 2013-07-03
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-03
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/03/20120703174816P040005202147001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2011-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HIGHWAY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HIGHWAY 51 N, BROOKHAVEN, MS, 39602

Plan administrator’s name and address
Administrator’s EIN 640333594
Plan administrator’s name KING'S DAUGHTERS MEDICAL CENTER
Plan administrator’s address P.O. BOX 948, 427 HIGHWAY 51 N, BROOKHAVEN, MS, 39602
Administrator’s telephone number 6018336011

Number of participants as of the end of the plan year
Active participants 457

Signature of
Role Plan administrator
Date 2012-07-03
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/29/20120629173157P030004511478001.pdf
Three-digit plan number (PN) 507
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018359381
Plan sponsor’s mailing address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39602
Plan sponsor’s address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39602

Plan administrator’s name and address
Administrator’s EIN 640333594
Plan administrator’s name KING'S DAUGHTERS MEDICAL CENTER
Plan administrator’s address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39602
Administrator’s telephone number 6018359381

Number of participants as of the end of the plan year
Active participants 208

Signature of
Role Plan administrator
Date 2012-06-27
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-29
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/06/20120706085314P030165240752001.pdf
Three-digit plan number (PN) 502
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Plan administrator’s name and address
Administrator’s EIN 640333594
Plan administrator’s name KING'S DAUGHTERS MEDICAL CENTER
Plan administrator’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Administrator’s telephone number 6018336011

Number of participants as of the end of the plan year
Active participants 285

Signature of
Role Plan administrator
Date 2012-07-03
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-05
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/03/20120703174743P040051287442001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Plan administrator’s name and address
Administrator’s EIN 640333594
Plan administrator’s name KING'S DAUGHTERS MEDICAL CENTER
Plan administrator’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Administrator’s telephone number 6018336011

Number of participants as of the end of the plan year
Active participants 425

Signature of
Role Plan administrator
Date 2012-07-03
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/29/20120629173221P030004511494001.pdf
Three-digit plan number (PN) 507
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018359381
Plan sponsor’s mailing address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39601
Plan sponsor’s address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39601

Plan administrator’s name and address
Administrator’s EIN 640333594
Plan administrator’s name KING'S DAUGHTERS MEDICAL CENTER
Plan administrator’s address 427 HWY 51 N, P.O. BOX 948, BROOKHAVEN, MS, 39601
Administrator’s telephone number 6018359381

Number of participants as of the end of the plan year
Active participants 206

Signature of
Role Plan administrator
Date 2012-06-27
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-29
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/06/20120706085248P040053255986001.pdf
Three-digit plan number (PN) 502
Effective date of plan 2006-02-01
Business code 622000
Sponsor’s telephone number 6018336011
Plan sponsor’s mailing address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Plan sponsor’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602

Plan administrator’s name and address
Administrator’s EIN 640333594
Plan administrator’s name KING'S DAUGHTERS MEDICAL CENTER
Plan administrator’s address P.O. BOX 948, 427 HWY 51 N, BROOKHAVEN, MS, 39602
Administrator’s telephone number 6018336011

Number of participants as of the end of the plan year
Active participants 279

Signature of
Role Plan administrator
Date 2012-07-03
Name of individual signing CELINE CRAIG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-05
Name of individual signing ALVIN HOOVER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Scott Christensen Agent 427 Highway 51 North, Brookhaven, MS 39601

Incorporator

Name Role Address
Mary Bowen Incorporator B, Brookhaven, MS
Mary Hartman Incorporator B, Brookhaven, MS
Mary McNair Incorporator B, Brookhaven, MS

Director

Name Role Address
William O. Jacobs Director 1858 E. Lincoln Rd. SE, Brookhaven, MS 39601
Cathy Ditcharo Director 46 Eola Trail NE, Brookhaven, MS 39601
Sarah Foster Director 727 W. Chippewa, Brookhaven, MS 39601
Robyn Aker Director 422 Margaret St., Brookhaven, MS 39601
Joshua Iles Director 2581 Warren Rd. SE, Brookhaven, MS 39601
Sherra Smith Director 1816 Smith Lake Rd NE, Brookhaven, MS 39601
Sylvia Campbell Director 2139 Campbell Lane NW, Brookhaven, MS 39601
Ryan Case Director 307 Natchez Ave., Brookhaven, MS 39601
Michael Tanner Director 300 Truvillion Trl. NE, Brookhaven, MS 39601
Clint Gardner Director P.O. Box 1163, Brookhaven, MS 39601

Treasurer

Name Role Address
William O. Jacobs Treasurer 1858 E. Lincoln Rd. SE, Brookhaven, MS 39601

Secretary

Name Role Address
Cathy Ditcharo Secretary 46 Eola Trail NE, Brookhaven, MS 39601

Chief Executive Officer

Name Role Address
Scott Christensen Chief Executive Officer 427 Highway 51 N, Brookhaven, MS 39601

Chief Financial Officer

Name Role Address
Adam Moore Chief Financial Officer 427 HWY 51 N, Brookhaven, MS 39601

Filings

Type Status Filed Date Description
Amendment Form Filed 2024-09-30 Amendment For KING'S DAUGHTERS MEDICAL CENTER
Non-Profit Status Report Filed 2023-10-02 Status Report For KING'S DAUGHTERS MEDICAL CENTER
Non-Profit Status Report Filed 2023-08-08 Status Report For KING'S DAUGHTERS MEDICAL CENTER
Non-Profit Status Report Filed 2023-06-06 Status Report For KING'S DAUGHTERS MEDICAL CENTER
Amendment Form Filed 2023-03-10 Amendment For KING'S DAUGHTERS MEDICAL CENTER
Reinstatement Tax Filed 2023-03-09 Tax Clearance Letter
Non-Profit Status Report Filed 2022-10-06 Status Report For KING'S DAUGHTERS MEDICAL CENTER
Non-Profit Status Report Filed 2022-05-03 Status Report For KING'S DAUGHTERS MEDICAL CENTER
Non-Profit Status Report Filed 2021-10-08 Status Report For KING'S DAUGHTERS MEDICAL CENTER
Non-Profit Status Report Filed 2021-03-04 Status Report For KING'S DAUGHTERS MEDICAL CENTER

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Scott Christensen

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427 Highway 51 NorthBrookhaven, MS 39601

South Mississippi Wound Management, LLC

Date of last update: 25 Dec 2024

Sources: Mississippi Secretary of State

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