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  5. NATCHEZ PEDIATRIC CLINIC, PLLC

NATCHEZ PEDIATRIC CLINIC, PLLC

Company Details

Name: NATCHEZ PEDIATRIC CLINIC, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 13 Jan 2000 (25 years ago)
Business ID: 680675
ZIP code: 39120
County: Adams
State of Incorporation: MISSISSIPPI
Principal Office Address: 136 Jefferson Davis BlvdNatchez, MS 39120

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2023 640920110 2024-10-02 NATCHEZ PEDIATRIC CLINIC PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2024-10-02
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2022 640920110 2023-03-07 NATCHEZ PEDIATRIC CLINIC PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2023-03-07
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2021 640920110 2022-06-30 NATCHEZ PEDIATRIC CLINIC PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2022-06-30
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2020 640920110 2021-07-15 NATCHEZ PEDIATRIC CLINIC PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2019 640920110 2020-07-21 NATCHEZ PEDIATRIC CLINIC PLLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2020-07-21
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2018 640920110 2019-06-19 NATCHEZ PEDIATRIC CLINIC PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2019-06-19
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2017 640920110 2018-03-22 NATCHEZ PEDIATRIC CLINIC PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2018-03-22
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2016 640920110 2017-07-21 NATCHEZ PEDIATRIC CLINIC PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2017-07-21
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2015 640920110 2016-06-29 NATCHEZ PEDIATRIC CLINIC PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2016-06-29
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-29
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
NATCHEZ PEDIATRIC CLINIC PLLC 401(K) PLAN 2014 640920110 2015-07-27 NATCHEZ PEDIATRIC CLINIC PLLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2015-07-27
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-27
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/14/20140714160130P030003261461001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2014-07-14
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-14
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/17/20130717144856P040307882355001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104

Signature of
Role Plan administrator
Date 2013-07-17
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-17
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/18/20120618145610P030003775654001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104

Plan administrator’s name and address
Administrator’s EIN 640920110
Plan administrator’s name NATCHEZ PEDIATRIC CLINIC PLLC
Plan administrator’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104
Administrator’s telephone number 6014425439

Signature of
Role Plan administrator
Date 2012-06-18
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-18
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/28/20110628160524P040086437329001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104

Plan administrator’s name and address
Administrator’s EIN 640920110
Plan administrator’s name NATCHEZ PEDIATRIC CLINIC PLLC
Plan administrator’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104
Administrator’s telephone number 6014425439

Signature of
Role Plan administrator
Date 2011-06-28
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-28
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/06/22/20100622100459P030109511218001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2003-05-13
Business code 621111
Sponsor’s telephone number 6014425439
Plan sponsor’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104

Plan administrator’s name and address
Administrator’s EIN 640920110
Plan administrator’s name NATCHEZ PEDIATRIC CLINIC PLLC
Plan administrator’s address PO BOX 17918, 136 JEFFERSON DAVIS BLVD STE A, NATCHEZ, MS, 391205104
Administrator’s telephone number 6014425439

Signature of
Role Plan administrator
Date 2010-06-08
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-06-08
Name of individual signing MONTY MAYO
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
Monty Mayo Manager 136 JEFFERSON DAVIS BLVD., NATCHEZ, MS 39120

Agent

Name Role Address
CHRISTOPHER E. KELLEY Agent 319 MARKET STREET, P O BOX 1344, NATCHEZ, MS 39121

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2024-04-15 Annual Report For NATCHEZ PEDIATRIC CLINIC, PLLC
Annual Report LLC Filed 2023-04-14 Annual Report For NATCHEZ PEDIATRIC CLINIC, PLLC
Annual Report LLC Filed 2022-10-18 Annual Report For NATCHEZ PEDIATRIC CLINIC, PLLC
Notice to Dissolve/Revoke Filed 2022-09-05 Notice of Intent to Dissolve: AR: NATCHEZ PEDIATRIC CLINIC, PLLC
Annual Report LLC Filed 2021-05-12 Annual Report For NATCHEZ PEDIATRIC CLINIC, PLLC
Annual Report LLC Filed 2020-03-26 Annual Report For NATCHEZ PEDIATRIC CLINIC, PLLC
Annual Report LLC Filed 2019-01-07 Annual Report For NATCHEZ PEDIATRIC CLINIC, PLLC
Annual Report LLC Filed 2018-01-12 Annual Report For NATCHEZ PEDIATRIC CLINIC, PLLC
Reinstatement Filed 2017-05-22 Reinstatement For NATCHEZ PEDIATRIC CLINIC, PLLC
Admin Dissolution Filed 2015-12-08 Admin Dissolution: AR

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4045938305 2021-01-22 0470 PPS 136 Jefferson Davis Blvd, Natchez, MS, 39120-5104
Loan Status Date 2022-04-23
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 177000
Loan Approval Amount (current) 177000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39638
Servicing Lender Name United Mississippi Bank
Servicing Lender Address 75 Melrose Montebello Pkwy, NATCHEZ, MS, 39120-4747
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address Natchez, ADAMS, MS, 39120-5104
Project Congressional District MS-03
Number of Employees 11
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 39638
Originating Lender Name United Mississippi Bank
Originating Lender Address NATCHEZ, MS
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 178917.5
Forgiveness Paid Date 2022-02-17
5797217008 2020-04-06 0470 PPP 136 JEFFERSON DAVIS BLVD, NATCHEZ, MS, 39120-5104
Loan Status Date 2021-02-19
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 177000
Loan Approval Amount (current) 177000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39638
Servicing Lender Name United Mississippi Bank
Servicing Lender Address 75 Melrose Montebello Pkwy, NATCHEZ, MS, 39120-4747
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address NATCHEZ, ADAMS, MS, 39120-5104
Project Congressional District MS-03
Number of Employees 13
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 39638
Originating Lender Name United Mississippi Bank
Originating Lender Address NATCHEZ, MS
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 178435.67
Forgiveness Paid Date 2021-01-27

Related by officers

Monty Mayo

KCLCM, LLC

CHRISTOPHER E. KELLEY

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Date of last update: 18 Mar 2025

Sources: Mississippi Secretary of State

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