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Southern Anesthesia of MS, Inc.

Company Details

Name: Southern Anesthesia of MS, Inc.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 16 Nov 2005 (19 years ago)
Business ID: 881583
ZIP code: 39465
County: Forrest
State of Incorporation: MISSISSIPPI
Principal Office Address: 1 Mockingbird Lane, PO Box 6Petal, MS 39465
Historical names: Southern Anesthesia, Inc

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2020 203844511 2021-10-14 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2021-10-14
Name of individual signing DAVID J WARE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-14
Name of individual signing DAVID J WARE
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2019 203844511 2020-07-13 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2020-07-13
Name of individual signing DAVID J WARE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-13
Name of individual signing DAVID J WARE
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2018 203844511 2019-06-06 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2019-06-06
Name of individual signing DAVE J. WARE II
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-06
Name of individual signing DAVE J. WARE II
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2017 203844511 2018-07-09 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6018497353
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2018-07-09
Name of individual signing DAVE J WARE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-09
Name of individual signing DAVE J WARE
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2016 203844511 2017-05-01 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6018497353
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2017-05-01
Name of individual signing DAVE WARE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-01
Name of individual signing DAVE WARE
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2015 203844511 2016-05-24 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6018497353
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2016-05-24
Name of individual signing DAVE WARE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-24
Name of individual signing DAVE WARE
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2014 203844511 2016-09-20 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6018497353
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2016-09-20
Name of individual signing DAVE WARE
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2013 203844511 2014-04-18 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2014-04-18
Name of individual signing DAVE J. WARE II
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2012 203844511 2013-10-02 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Signature of

Role Plan administrator
Date 2013-10-02
Name of individual signing DAVE J. WARE II
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-02
Name of individual signing DAVE J. WARE II
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ANESTHESIA 401(K) PROFIT SHARING PLAN 2011 203844511 2012-07-21 SOUTHERN ANESTHESIA INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Plan administrator’s name and address

Administrator’s EIN 203844511
Plan administrator’s name SOUTHERN ANESTHESIA INC.
Plan administrator’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401
Administrator’s telephone number 6012977629

Signature of

Role Plan administrator
Date 2012-07-21
Name of individual signing DAVE WARE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-21
Name of individual signing DAVE WARE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/05/26/20110526162320P030308982720001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Plan administrator’s name and address

Administrator’s EIN 203844511
Plan administrator’s name SOUTHERN ANESTHESIA, INC.
Plan administrator’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401
Administrator’s telephone number 6012977629

Signature of

Role Plan administrator
Date 2011-05-26
Name of individual signing DAVID J. WARE II
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-26
Name of individual signing DAVID J. WARE II
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Plan administrator’s name and address

Administrator’s EIN 203844511
Plan administrator’s name SOUTHERN ANESTHESIA, INC.
Plan administrator’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401
Administrator’s telephone number 6012977629
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Plan administrator’s name and address

Administrator’s EIN 203844511
Plan administrator’s name SOUTHERN ANESTHESIA, INC.
Plan administrator’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401
Administrator’s telephone number 6012977629

Signature of

Role Plan administrator
Date 2010-09-10
Name of individual signing DAVID J. WARE, II
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-10
Name of individual signing DAVID J. WARE, II
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Plan administrator’s name and address

Administrator’s EIN 203844511
Plan administrator’s name SOUTHERN ANESTHESIA, INC.
Plan administrator’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401
Administrator’s telephone number 6012977629

Signature of

Role Plan administrator
Date 2010-09-10
Name of individual signing DAVID J. WARE, II
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-10
Name of individual signing DAVID J. WARE, II
Valid signature Filed with incorrect/unrecognized electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/10/20100910142405P030490524465001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 6012977629
Plan sponsor’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401

Plan administrator’s name and address

Administrator’s EIN 203844511
Plan administrator’s name SOUTHERN ANESTHESIA, INC.
Plan administrator’s address 402 REBECCA AVENUE, HATTIESBURG, MS, 39401
Administrator’s telephone number 6012977629

Signature of

Role Plan administrator
Date 2010-09-10
Name of individual signing DAVID J. WARE, II
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Greg Sims Agent 1 Mockingbird Lane, Petal, MS 39465

Incorporator

Name Role Address
Ghates, Audry Incorporator 135 Pearce Road, Mount Olive, MS 39119
Ware, David Incorporator 402 Rebecca Ave, Hattiesburg, MS 39401

Director

Name Role Address
Greg Sims Director 1 Mockingbird Lane, Petal, MS 39465

President

Name Role Address
Greg Sims President 1 Mockingbird Lane, Petal, MS 39465

Filings

Type Status Filed Date Description
Amendment Form Filed 2024-06-19 Amendment For Southern Anesthesia of MS, Inc.
Annual Report Filed 2024-05-08 Annual Report For Southern Anesthesia of MS, Inc.
Annual Report Filed 2023-06-06 Annual Report For Southern Anesthesia of MS, Inc.
Annual Report Filed 2022-04-19 Annual Report For Southern Anesthesia of MS, Inc.
Annual Report Filed 2021-05-17 Annual Report For Southern Anesthesia of MS, Inc.
Annual Report Filed 2020-03-17 Annual Report For Southern Anesthesia of MS, Inc.
Annual Report Filed 2019-04-03 Annual Report For Southern Anesthesia of MS, Inc.
Annual Report Filed 2018-06-05 Annual Report For Southern Anesthesia of MS, Inc.
Annual Report Filed 2017-01-18 Annual Report For Southern Anesthesia of MS, Inc.
Annual Report Filed 2016-04-18 Annual Report For Southern Anesthesia of MS, Inc.

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6201837000 2020-04-06 0470 PPP 135 Pearce Road, Mt Olive, MS, 39119-5113
Loan Status Date 2021-04-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 41666.65
Loan Approval Amount (current) 41666.65
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39546
Servicing Lender Name PriorityOne Bank
Servicing Lender Address 220 Main Ave N, MAGEE, MS, 39111-3536
Rural or Urban Indicator R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Mt Olive, LAMAR, MS, 39119-5113
Project Congressional District MS-03
Number of Employees 2
NAICS code 621493
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 39546
Originating Lender Name PriorityOne Bank
Originating Lender Address MAGEE, MS
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 42067.33
Forgiveness Paid Date 2021-04-01

Date of last update: 20 Mar 2025

Sources: Mississippi Secretary of State