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  5. DELTA HEALTH ALLIANCE, INC.

DELTA HEALTH ALLIANCE, INC.

Company Details

Name: DELTA HEALTH ALLIANCE, INC.
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 13 Dec 2001 (23 years ago)
Business ID: 710435
ZIP code: 38776
County: Washington
State of Incorporation: MISSISSIPPI
Principal Office Address: 435 Stoneville RoadStoneville, MS 38776

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DELTA HEALTH ALLIANCE, INC. 401(K) RETIREMENT PLAN 2017 470915576 2018-10-08 DELTA HEALTH ALLIANCE, INC. 85
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626867004
Plan sponsor’s address 435 STONEVILLE ROAD, LELAND, MS, 38756

Signature of
Role Plan administrator
Date 2018-10-07
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-07
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. 401(K) RETIREMENT PLAN 2017 470915576 2018-10-29 DELTA HEALTH ALLIANCE, INC. 0
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626867004
Plan sponsor’s address 435 STONEVILLE ROAD, LELAND, MS, 38756

Signature of
Role Plan administrator
Date 2018-10-29
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-29
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. RETIREMENT PLAN 2017 470915576 2018-10-08 DELTA HEALTH ALLIANCE, INC. 76
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626867004
Plan sponsor’s address 435 STONEVILLE ROAD, LELAND, MS, 38756

Signature of
Role Plan administrator
Date 2018-10-07
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-07
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. RETIREMENT PLAN 2016 470915576 2017-10-02 DELTA HEALTH ALLIANCE, INC. 85
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626867004
Plan sponsor’s address 435 STONEVILLE ROAD, LELAND, MS, 38756

Signature of
Role Plan administrator
Date 2017-10-02
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-02
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. 401(K) RETIREMENT PLAN 2016 470915576 2017-10-02 DELTA HEALTH ALLIANCE, INC. 51
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626867004
Plan sponsor’s address 435 STONEVILLE ROAD, LELAND, MS, 38756

Signature of
Role Plan administrator
Date 2017-10-02
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-02
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. 401(K) RETIREMENT PLAN 2015 470915576 2016-09-30 DELTA HEALTH ALLIANCE, INC. 38
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626867004
Plan sponsor’s address 435 STONEVILLE ROAD, LELAND, MS, 38756

Signature of
Role Plan administrator
Date 2016-09-30
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-30
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. RETIREMENT PLAN 2015 470915576 2016-09-30 DELTA HEALTH ALLIANCE, INC. 99
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626867004
Plan sponsor’s address 435 STONEVILLE ROAD, LELAND, MS, 38756

Signature of
Role Plan administrator
Date 2016-09-30
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-30
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. 401(K) RETIREMENT PLAN 2014 470915576 2015-10-02 DELTA HEALTH ALLIANCE, INC. 52
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Signature of
Role Plan administrator
Date 2015-10-02
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-02
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. RETIREMENT PLAN 2014 470915576 2015-10-02 DELTA HEALTH ALLIANCE, INC. 51
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Signature of
Role Plan administrator
Date 2015-10-02
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-02
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
DELTA HEALTH ALLIANCE, INC. RETIREMENT PLAN 2013 470915576 2014-10-10 DELTA HEALTH ALLIANCE, INC. 40
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/12/22/20141222160130P030017963457001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/12/22/20141222155936P040012560599001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/09/27/20130927103459P040000618567001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Signature of
Role Plan administrator
Date 2013-09-27
Name of individual signing KIM DANG - AS PRACTITIONER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/09/27/20130927103219P040000617623001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Signature of
Role Plan administrator
Date 2013-09-27
Name of individual signing KIM DANG - AS PRACTITIONER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/16/20120916083703P030006184740001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2011-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Plan administrator’s name and address
Administrator’s EIN 470915576
Plan administrator’s name DELTA HEALTH ALLIANCE, INC.
Plan administrator’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
Administrator’s telephone number 6626863520

Signature of
Role Plan administrator
Date 2012-09-16
Name of individual signing KIM DANG - AS PRACTITIONER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/16/20120916084144P030003453173001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Plan administrator’s name and address
Administrator’s EIN 470915576
Plan administrator’s name DELTA HEALTH ALLIANCE, INC.
Plan administrator’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
Administrator’s telephone number 6626863520

Signature of
Role Plan administrator
Date 2012-09-16
Name of individual signing KIM DANG - AS PRACTITIONER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/09/20/20110920163415P030133782305001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Plan administrator’s name and address
Administrator’s EIN 470915576
Plan administrator’s name DELTA HEALTH ALLIANCE, INC.
Plan administrator’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
Administrator’s telephone number 6626863520

Signature of
Role Plan administrator
Date 2011-09-20
Name of individual signing KIM DANG AS PRACTITIONER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/09/21/20110921065707P030134123729001.pdf
Three-digit plan number (PN) 003
Effective date of plan 2010-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Plan administrator’s name and address
Administrator’s EIN 470915576
Plan administrator’s name DELTA HEALTH ALLIANCE, INC.
Plan administrator’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
Administrator’s telephone number 6626863520

Signature of
Role Plan administrator
Date 2011-09-21
Name of individual signing KIM DANG AS PRACTITIONER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/09/20/20110920162548P040137042705001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 541990
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776

Plan administrator’s name and address
Administrator’s EIN 470915576
Plan administrator’s name DELTA HEALTH ALLIANCE, INC.
Plan administrator’s address 435 STONEVILLE ROAD, STONEVILLE, MS, 38776
Administrator’s telephone number 6626863520

Signature of
Role Plan administrator
Date 2011-09-20
Name of individual signing KIM DANG AS PRACTITIONER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/09/20100909104303P040487946545001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 624100
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE RD., STONEVILLE, MS, 38776

Plan administrator’s name and address
Administrator’s EIN 470915546
Plan administrator’s name DELTA HEALTH ALLIANCE INC.
Plan administrator’s address 435 STONEVILLE RD., STONEVILLE, MS, 38776
Administrator’s telephone number 6626863520

Signature of
Role Plan administrator
Date 2010-09-09
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/09/20100909104203P040050099651001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624100
Sponsor’s telephone number 6626863520
Plan sponsor’s address 435 STONEVILLE RD., STONEVILLE, MS, 38776

Plan administrator’s name and address
Administrator’s EIN 470915576
Plan administrator’s name DELTA HEALTH ALLIANCE INC.
Plan administrator’s address 435 STONEVILLE RD., STONEVILLE, MS, 38776
Administrator’s telephone number 6626863520

Signature of
Role Plan administrator
Date 2010-09-09
Name of individual signing HENRY WOMACK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Henry marlin womack Junior Agent 435 Stoneville Road, Leland, MS 38756

Incorporator

Name Role Address
MELVIN V PRIESTER Incorporator 371 EDGEWOOD TERRACE DRIVE, JACKSON, MS 39206

President

Name Role Address
Karen C. Matthews President 641 South McLean, Memphis, TN 38104

Chief Executive Officer

Name Role Address
Karen C. Matthews Chief Executive Officer 641 South McLean, Memphis, TN 38104

Vice President

Name Role Address
Henry Marlin Womack Jr Vice President 119 Lilac Drive, Leland, MS 38756
Brooks Ann Gaston Vice President 105 Williamsburg cove, oxford, MS 38655

Chief Financial Officer

Name Role Address
Henry Marlin Womack Jr Chief Financial Officer 119 Lilac Drive, Leland, MS 38756

Director

Name Role Address
Lisa Percy Director 134 Bayou Road, Greenville, MS 38701
William Kennedy Director 13 Kennedy Rd., Inverness, MS 38753
Willie Bailey Director 218 Theobald St., Greenville, MS 38701
Woods Eastland Director 1304 Bayou Drive, Indianola, MS 38751
Myrtis Tabb Director 1311 College St., Cleveland, MS 38732
Joyce McNair Director 512 Holmes St., Belzoni, MS 39038
Randy Easterling MD Director P. O. Box 690, Vicksburg, MS 39180
Joe Nash Director 1325 Olive, Jackson, MS 39202
Don Green Director P. O. Box 1414, Clarksdale, MS 38614

Secretary

Name Role Address
Lisa Percy Secretary 134 Bayou Road, Greenville, MS 38701

Chairman

Name Role Address
William Kennedy Chairman 13 Kennedy Rd., Inverness, MS 38753

Filings

Type Status Filed Date Description
Non-Profit Status Report Filed 2024-04-11 Status Report For DELTA HEALTH ALLIANCE, INC.
Amendment Form Filed 2021-03-01 Amendment For DELTA HEALTH ALLIANCE, INC.
Non-Profit Status Report Filed 2021-01-28 Status Report For DELTA HEALTH ALLIANCE, INC.
Non-Profit Status Report Filed 2020-05-18 Status Report For DELTA HEALTH ALLIANCE, INC.
Non-Profit Status Report Filed 2019-07-03 Status Report For DELTA HEALTH ALLIANCE, INC.
Amendment Form Filed 2011-02-01 Amendment
Amendment Form Filed 2002-12-10 Amendment
Name Reservation Form Filed 2001-12-13 Name Reservation

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MELVIN V PRIESTER

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William Kennedy

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Willie Bailey

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Woods Eastland

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Myrtis Tabb

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Joyce McNair

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Joe Nash

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Related by address

No related companies by address

Date of last update: 28 Dec 2024

Sources: Mississippi Secretary of State

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