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Tupelo Plastic Surgery Clinic, P.A.

Company Details

Name: Tupelo Plastic Surgery Clinic, P.A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 19 Oct 2005 (19 years ago)
Business ID: 880076
ZIP code: 38801
County: Lee
State of Incorporation: MISSISSIPPI
Principal Office Address: 499 Gloster Creek Village, Suite D-4Tupelo, MS 38801

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2023 203590698 2024-03-28 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S. EASON BLVD., SUITE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2024-03-28
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-03-28
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2022 203590698 2023-05-31 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2023-05-31
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-05-31
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2021 203590698 2022-03-10 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2022-03-10
Name of individual signing BOB BUCKLEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-03-10
Name of individual signing BOB BUCKLEY
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2020 203590698 2021-03-10 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2021-03-10
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-03-10
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2019 203590698 2020-05-14 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2020-05-14
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-14
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2018 203590698 2019-09-04 TUPELO PLASTIC SURGERY CLINIC P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2019-09-04
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-09-04
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2017 203590698 2018-05-21 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2018-05-21
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-21
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2016 203590698 2017-06-19 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2017-06-19
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-19
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2015 203590698 2016-06-08 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016586

Signature of

Role Plan administrator
Date 2016-06-08
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-08
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
TUPELO PLASTIC SURGERY CLINIC P A 401(K) PLAN 2014 203590698 2015-06-24 TUPELO PLASTIC SURGERY CLINIC P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583

Signature of

Role Plan administrator
Date 2015-06-24
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-24
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/03/20140903144658P030112796359001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583

Signature of

Role Plan administrator
Date 2014-09-03
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-09-03
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/09/23/20130923090806P040001077509001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583

Signature of

Role Plan administrator
Date 2013-09-23
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-23
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/04/20120604141106P040028848578001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583

Plan administrator’s name and address

Administrator’s EIN 203590698
Plan administrator’s name TUPELO PLASTIC SURGERY CLINIC P A
Plan administrator’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583
Administrator’s telephone number 6623776630

Signature of

Role Plan administrator
Date 2012-06-04
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-04
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/09/19/20110919114143P030132974961001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583

Plan administrator’s name and address

Administrator’s EIN 203590698
Plan administrator’s name TUPELO PLASTIC SURGERY CLINIC P A
Plan administrator’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583
Administrator’s telephone number 6623776630

Signature of

Role Plan administrator
Date 2011-09-19
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-19
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/04/20101004104309P030002736130001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6623776630
Plan sponsor’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583

Plan administrator’s name and address

Administrator’s EIN 203590698
Plan administrator’s name TUPELO PLASTIC SURGERY CLINIC P A
Plan administrator’s address LONGTOWN MEDICAL PARK, 4381 S EASON BLVD STE 101, TUPELO, MS, 388016583
Administrator’s telephone number 6623776630

Signature of

Role Plan administrator
Date 2010-10-04
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-04
Name of individual signing SHANNON DRUMMOND
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Vance, James E Agent 825 Jefferson Street;P O Box 1280, Tupelo, MS 38802

Incorporator

Name Role Address
James E Vance Incorporator 825 Jefferson Street, Tupelo, MS 38804

Director

Name Role Address
Robert C. Buckley Director 4139 Meadow Circle, Belden, MS 38826

President

Name Role Address
Robert C. Buckley President 4139 Meadow Circle, Belden, MS 38826

Secretary

Name Role Address
Robert C. Buckley Secretary 4139 Meadow Circle, Belden, MS 38826

Filings

Type Status Filed Date Description
Annual Report Filed 2024-04-11 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2023-04-04 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2022-04-08 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2021-04-01 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2020-03-19 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2019-04-01 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2018-04-11 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2017-08-04 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2017-02-24 Annual Report For Tupelo Plastic Surgery Clinic, P.A.
Annual Report Filed 2016-02-11 Annual Report For Tupelo Plastic Surgery Clinic, P.A.

Date of last update: 31 Dec 2024

Sources: Mississippi Secretary of State