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  5. FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.

FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.

Company Details

Name: FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 12 Aug 2002 (23 years ago)
Business ID: 721171
ZIP code: 38672
County: DeSoto
State of Incorporation: MISSISSIPPI
Principal Office Address: 3451 GOODMAN ROAD;SUITE 115SOUTHAVEN, MS 38672

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2018 331019957 2019-05-31 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 61
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Signature of
Role Plan administrator
Date 2019-05-31
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-31
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2018 331019957 2019-04-22 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Signature of
Role Plan administrator
Date 2019-04-22
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-04-22
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2017 331019957 2018-10-08 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Signature of
Role Plan administrator
Date 2018-10-08
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-08
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2016 331019957 2017-06-02 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 57
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Signature of
Role Plan administrator
Date 2017-06-02
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-02
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2015 331019957 2016-10-10 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Signature of
Role Plan administrator
Date 2016-10-10
Name of individual signing SHERRY MULLINS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-10
Name of individual signing SHERRY MULLINS
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2014 331019957 2015-07-13 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Signature of
Role Plan administrator
Date 2015-07-13
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-13
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2013 331019957 2014-07-08 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Signature of
Role Plan administrator
Date 2014-07-08
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-08
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2012 331019957 2013-07-18 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Signature of
Role Plan administrator
Date 2013-07-16
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-16
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2011 331019957 2012-04-18 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Plan administrator’s name and address
Administrator’s EIN 331019957
Plan administrator’s name FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Plan administrator’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672
Administrator’s telephone number 6628905555

Signature of
Role Plan administrator
Date 2012-04-17
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-04-17
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 401(K) PLAN 2010 331019957 2011-02-17 FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Plan administrator’s name and address
Administrator’s EIN 331019957
Plan administrator’s name FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Plan administrator’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672
Administrator’s telephone number 6628905555

Signature of
Role Plan administrator
Date 2011-02-16
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-02-16
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/27/20100727132251P070024829250001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6628905555
Plan sponsor’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672

Plan administrator’s name and address
Administrator’s EIN 331019957
Plan administrator’s name FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Plan administrator’s address 3451 GOODMAN ROAD, SUITE 115, SOUTHAVEN, MS, 38672
Administrator’s telephone number 6628905555

Signature of
Role Plan administrator
Date 2010-07-27
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-27
Name of individual signing ROBERT SKINNER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Skinner, Robert Agent 4611 SPRING MEADOW WAY SOUTH, Olive Branch, MS 38654

Incorporator

Name Role Address
Robert Skinner Incorporator 4839 Stone Park Blvd, Olive Branch, MS 38654
Anthony Hunt Incorporator 987 St Paul Road, Byhalia, MS 38611

Director

Name Role Address
Robert Skinner Director 4611 Spring Meadow Way South, Olive Branch, MS 38654
Jennie Skinner Director 4611 SPRING MEADOW WAY SOUTH, Olive Branch, MS 38654
Joe Pitts Director 884 TASKA RD, Red Banks, MS 38661

President

Name Role Address
Robert Skinner President 4611 Spring Meadow Way South, Olive Branch, MS 38654

Vice President

Name Role Address
Jennie Skinner Vice President 4611 SPRING MEADOW WAY SOUTH, Olive Branch, MS 38654

Treasurer

Name Role Address
Joe Pitts Treasurer 884 TASKA RD, Red Banks, MS 38661

Assistant Secretary

Name Role Address
Jeffery Geraci Assistant Secretary 3451 Goodman Road, Suite 115, Southaven, MS 38672

Filings

Type Status Filed Date Description
Annual Report Filed 2024-03-13 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Annual Report Filed 2023-02-10 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Amendment Form Filed 2022-06-03 Amendment For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Annual Report Filed 2022-04-11 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Annual Report Filed 2021-04-13 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Annual Report Filed 2021-03-19 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Annual Report Filed 2020-03-02 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Annual Report Filed 2019-03-26 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Annual Report Filed 2018-01-22 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.
Annual Report Filed 2017-01-25 Annual Report For FAMILY MEDICAL CLINIC OF NORTH MISSISSIPPI, INC.

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6028327104 2020-04-14 0470 PPP 3451 GOODMAN RD STE 115, SOUTHAVEN, MS, 38672-9304
Loan Status Date 2021-01-16
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 639500
Loan Approval Amount (current) 639500
Undisbursed Amount 0
Franchise Name -
Lender Location ID 40010
Servicing Lender Name Renasant Bank
Servicing Lender Address 209 Troy St, TUPELO, MS, 38804-4827
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address SOUTHAVEN, DESOTO, MS, 38672-9304
Project Congressional District MS-01
Number of Employees 62
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 40010
Originating Lender Name Renasant Bank
Originating Lender Address TUPELO, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 643425.55
Forgiveness Paid Date 2021-02-16

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Related by address

No related companies by address

Date of last update: 19 Mar 2025

Sources: Mississippi Secretary of State

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