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  5. JACKSON NEUROSURGERY CLINIC, PLLC

JACKSON NEUROSURGERY CLINIC, PLLC

Company Details

Name: JACKSON NEUROSURGERY CLINIC, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 19 Jan 1999 (26 years ago)
Business ID: 665866
ZIP code: 39232
County: Rankin
State of Incorporation: MISSISSIPPI
Principal Office Address: 1080 River Oaks Dr., Suite B103Flowood, MS 39232

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2021 640903138 2022-07-17 JACKSON NEUROSURGERY CLINIC, PLLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013661011
Plan sponsor’s address 1080 RIVER OAKS DR, SUITE B103, FLOWOOD, MS, 39232

Signature of
Role Plan administrator
Date 2022-07-17
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-17
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2020 640903138 2021-07-25 JACKSON NEUROSURGERY CLINIC, PLLC 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013661011
Plan sponsor’s address 1080 RIVER OAKS DR, SUITE B103, FLOWOOD, MS, 39232

Signature of
Role Plan administrator
Date 2021-07-23
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-23
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2019 640903138 2020-06-14 JACKSON NEUROSURGERY CLINIC, PLLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013661011
Plan sponsor’s address 1080 RIVER OAKS DR, SUITE B103, FLOWOOD, MS, 39232

Signature of
Role Plan administrator
Date 2020-06-14
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-14
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2018 640903138 2019-07-18 JACKSON NEUROSURGERY CLINIC, PLLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013661011
Plan sponsor’s address 1080 RIVER OAKS DR, SUITE B103, FLOWOOD, MS, 39232

Signature of
Role Plan administrator
Date 2019-07-18
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-18
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2017 640903138 2018-10-07 JACKSON NEUROSURGERY CLINIC, PLLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 1080 RIVER OAKS DR, SUITE B-103, FLOWOOD, MS, 39232

Signature of
Role Plan administrator
Date 2018-10-07
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-07
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2016 640903138 2017-07-17 JACKSON NEUROSURGERY CLINIC, PLLC 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 1080 RIVER OAKS DRIVE, SUITE B-103, FLOWOOD, MS, 39232

Signature of
Role Plan administrator
Date 2017-07-17
Name of individual signing ZOE LEWIS
Valid signature Filed with authorized/valid electronic signature
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2015 640903138 2016-08-01 JACKSON NEUROSURGERY CLINIC, PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 1080 RIVER OAKS DRIVE, SUITE B-103, FLOWOOD, MS, 39232
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2014 640903138 2015-07-07 JACKSON NEUROSURGERY CLINIC, PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216

Signature of
Role Plan administrator
Date 2015-07-07
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2013 640903138 2014-09-02 JACKSON NEUROSURGERY CLINIC, PLLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216

Signature of
Role Plan administrator
Date 2014-09-02
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-09-02
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
JACKSON NEUROSURGERY CLINIC, PLLC 401(K) PROFIT SHARING PLAN 2012 640903138 2013-05-06 JACKSON NEUROSURGERY CLINIC, PLLC 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216

Signature of
Role Plan administrator
Date 2013-05-06
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-06
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/05/23/20120523100817P030000708503001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216

Plan administrator’s name and address
Administrator’s EIN 640903138
Plan administrator’s name JACKSON NEUROSURGERY CLINIC, PLLC
Plan administrator’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216
Administrator’s telephone number 6013211513

Signature of
Role Plan administrator
Date 2012-05-23
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-05-23
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/04/05/20110405135522P030005462002001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216

Plan administrator’s name and address
Administrator’s EIN 640903138
Plan administrator’s name JACKSON NEUROSURGERY CLINIC, PLLC
Plan administrator’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216
Administrator’s telephone number 6013211513

Signature of
Role Plan administrator
Date 2011-04-05
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-04-05
Name of individual signing ADAM LEWIS, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/08/18/20100818143244P030150173106001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 6013211513
Plan sponsor’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216

Plan administrator’s name and address
Administrator’s EIN 640903138
Plan administrator’s name JACKSON NEUROSURGERY CLINIC, PLLC
Plan administrator’s address 971 LAKELAND DR, SUITE 1250, JACKSON, MS, 39216
Administrator’s telephone number 6013211513

Signature of
Role Plan administrator
Date 2010-08-18
Name of individual signing FRANK HARRISON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ADAM I LEWIS Agent 1080 River Oaks Dr., Suite B103, Flowood, MS 39232

Member

Name Role Address
Adam I Lewis Member 1080 River Oaks Dr., Suite B103, Flowood, MS 39232

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2024-03-20 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC
Annual Report LLC Filed 2023-04-26 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC
Annual Report LLC Filed 2022-04-24 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC
Annual Report LLC Filed 2021-04-12 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC
Annual Report LLC Filed 2020-05-18 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC
Annual Report LLC Filed 2019-05-24 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC
Annual Report LLC Filed 2018-04-15 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC
Amendment Form Filed 2017-04-14 Amendment For JACKSON NEUROSURGERY CLINIC, PLLC
Annual Report LLC Filed 2017-04-14 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC
Annual Report LLC Filed 2016-04-29 Annual Report For JACKSON NEUROSURGERY CLINIC, PLLC

Related by officers

ADAM I LEWIS

LEWIS PROPERTIES, LLC

Adam I Lewis

LEWIS MEDICAL SERVICES, PLLC Surgical Union, LLC Adam Lewis, PA Lewis Holdings, LLC Mississippi Back Institute, LLC Madison Spine Surgery Center, LLC ALT Spine, LLC Old Farm Inn, LLC Coon Hunter Properties, LLC Maybach Neurosurgery Clinic, LLC

Related by address

1080 River Oaks Dr., Suite B103Flowood, MS 39232

LEWIS MEDICAL SERVICES, PLLC

Date of last update: 25 Dec 2024

Sources: Mississippi Secretary of State

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