| Name: | Magnolia State Family Medicine, LLC |
| Jurisdiction: | MISSISSIPPI |
| Business Type: | Limited Liability Company |
| Status: | Dissolved |
| Effective Date: | 20 Jul 2007 (18 years ago) |
| Business ID: | 916052 |
| ZIP code: | 38663 |
| County: | Tippah |
| State of Incorporation: | MISSISSIPPI |
| Principal Office Address: | 1009B CITY AVENUE NORTHRIPLEY, MS 38663 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MAGNOLIA STATE FAMILY MEDICINE 401(K) PROFIT SHARING PLAN | 2012 | 260542139 | 2013-10-14 | MAGNOLIA STATE FAMILY MEDICINE | 6 | |||||||||||||||||||||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2013-10-14 |
| Name of individual signing | VICKY WALDEN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-10-14 |
| Name of individual signing | VICKY WALDEN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6629939458 |
| Plan sponsor’s address | 1009B CITY AVENUE NORTH, RIPLEY, MS, 38663 |
Plan administrator’s name and address
| Administrator’s EIN | 260542139 |
| Plan administrator’s name | MAGNOLIA STATE FAMILY MEDICINE |
| Plan administrator’s address | 1009B CITY AVENUE NORTH, RIPLEY, MS, 38663 |
| Administrator’s telephone number | 6629939458 |
Signature of
| Role | Plan administrator |
| Date | 2012-09-27 |
| Name of individual signing | CHRISTOPHER CUMMINS |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-09-27 |
| Name of individual signing | CHRISTOPHER CUMMINS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Christopher Cummins | Agent | 81 CR 849, Blue Mountain, MS 38610 |
| Name | Role | Address |
|---|---|---|
| Christopher J M Cummins | Manager | 1009B CITY AVENUE NORTH, RIPLEY, MS 38663 |
| Name | Role | Address |
|---|---|---|
| Christopher J. M. Cummins | Member | 1009B City Avenue North, Ripley, MS 38663 |
| Christopher J M Cummins | Member | 1009B CITY AVENUE NORTH, RIPLEY, MS 38663 |
| S. E. Donald, CPA | Member | 1417 Trailwood DriveP.O. Box 5546, Greenville, MS 38701 |
| Type | Status | Filed Date | Description |
|---|---|---|---|
| Admin Dissolution | Filed | 2016-11-30 | Admin Dissolution |
| Notice to Dissolve/Revoke | Filed | 2016-09-06 | Notice to Dissolve/Revoke |
| Amendment Form | Filed | 2015-08-10 | Amendment For Magnolia State Family Medicine, LLC |
| Annual Report LLC | Filed | 2015-02-28 | Annual Report For Magnolia State Family Medicine, LLC |
| Annual Report LLC | Filed | 2014-03-14 | Annual Report LLC |
| Annual Report LLC | Filed | 2013-01-22 | Annual Report LLC |
| Annual Report LLC | Filed | 2012-10-17 | Annual Report LLC |
| Notice to Dissolve/Revoke | Filed | 2012-09-14 | Notice to Dissolve/Revoke |
| Reinstatement | Filed | 2012-07-10 | Reinstatement |
| Amendment Form | Filed | 2012-07-10 | Amendment |
Date of last update: 02 Jan 2025
Sources: Mississippi Secretary of State
