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BERNARD GREEN INSURANCE, INC.

Company Details

Name: BERNARD GREEN INSURANCE, INC.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Dissolved
Effective Date: 12 May 2000 (25 years ago)
Business ID: 686791
ZIP code: 39402
County: Lamar
State of Incorporation: MISSISSIPPI
Principal Office Address: 17 Plaza Drive Ste 120Hattiesburg, MS 39402

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BERNARD GREEN INSURANCE INC 401(K) PLAN 2018 640926086 2019-06-24 BERNARD GREEN INSURANCE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Signature of

Role Plan administrator
Date 2019-06-24
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401(K) PLAN 2018 640926086 2019-08-05 BERNARD GREEN INSURANCE INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Signature of

Role Plan administrator
Date 2019-08-05
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401(K) PLAN 2017 640926086 2018-09-28 BERNARD GREEN INSURANCE INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Signature of

Role Plan administrator
Date 2018-09-28
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401(K) PLAN 2016 640926086 2017-10-10 BERNARD GREEN INSURANCE INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Signature of

Role Plan administrator
Date 2017-10-10
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401(K) PLAN 2015 640926086 2016-09-27 BERNARD GREEN INSURANCE INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Signature of

Role Plan administrator
Date 2016-09-27
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-27
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401K PLAN 2014 640926086 2015-09-15 BERNARD GREEN INSURANCE INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Signature of

Role Plan administrator
Date 2015-09-15
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-15
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401K PLAN 2013 640926086 2014-07-09 BERNARD GREEN INSURANCE INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Signature of

Role Plan administrator
Date 2014-07-09
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-09
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401K PLAN 2012 640926086 2013-05-24 BERNARD GREEN INSURANCE INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Signature of

Role Plan administrator
Date 2013-05-24
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-24
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401K PLAN 2011 640926086 2012-06-12 BERNARD GREEN INSURANCE INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Plan administrator’s name and address

Administrator’s EIN 640926086
Plan administrator’s name BERNARD GREEN INSURANCE INC
Plan administrator’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573
Administrator’s telephone number 6012641628

Signature of

Role Plan administrator
Date 2012-06-12
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-12
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
BERNARD GREEN INSURANCE INC 401K PLAN 2010 640926086 2011-06-27 BERNARD GREEN INSURANCE INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Plan administrator’s name and address

Administrator’s EIN 640926086
Plan administrator’s name BERNARD GREEN INSURANCE INC
Plan administrator’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573
Administrator’s telephone number 6012641628

Signature of

Role Plan administrator
Date 2011-06-27
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-27
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/19/20100719113302P030086987016001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 524210
Sponsor’s telephone number 6012641628
Plan sponsor’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573

Plan administrator’s name and address

Administrator’s EIN 640926086
Plan administrator’s name BERNARD GREEN INSURANCE INC
Plan administrator’s address 17 PLAZA DR STE 120, HATTIESBURG, MS, 394021573
Administrator’s telephone number 6012641628

Signature of

Role Plan administrator
Date 2010-07-19
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-19
Name of individual signing BERNARD GREEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BERNARD GREEN Agent 17 Plaza Drive Ste 120, Hattiesburg, MS 39402

Incorporator

Name Role Address
Bernard Green Incorporator 219-d South 40th Ave, Hattiesburg, MS 39402

Director

Name Role Address
Bernard Green Director 17 Plaza Drive Suite 120, Hattiesburg, MS 39402

President

Name Role Address
Bernard Green President 17 Plaza Drive Suite 120, Hattiesburg, MS 39402

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2018-12-10 Admin Dissolution: AR
Notice to Dissolve/Revoke Filed 2018-09-07 Notice to Dissolve/Revoke
Annual Report Filed 2017-02-28 Annual Report For BERNARD GREEN INSURANCE, INC.
Annual Report Filed 2016-08-12 Annual Report For BERNARD GREEN INSURANCE, INC.
Annual Report Filed 2015-09-24 Annual Report For BERNARD GREEN INSURANCE, INC.
Notice to Dissolve/Revoke Filed 2015-09-16 Notice to Dissolve/Revoke
Annual Report Filed 2014-04-22 Annual Report
Annual Report Filed 2013-06-05 Annual Report
Annual Report Filed 2012-07-26 Annual Report
Annual Report Filed 2011-03-23 Annual Report

Date of last update: 26 Dec 2024

Sources: Mississippi Secretary of State