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  5. TUPELO ANESTHESIA GROUP, P. A.

TUPELO ANESTHESIA GROUP, P. A.

Company Details

Name: TUPELO ANESTHESIA GROUP, P. A.
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Good Standing
Effective Date: 25 Nov 1970 (54 years ago)
Business ID: 408682
ZIP code: 38801
County: Lee
State of Incorporation: MISSISSIPPI
Principal Office Address: 830 South Gloster Street, 2nd FloorTupelo, MS 38801

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2023 640503363 2024-06-24 TUPELO ANESTHESIA GROUP, P.A. 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address PO BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2024-06-24
Name of individual signing RICHARD A. MCCLUNEY, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2022 640503363 2023-06-29 TUPELO ANESTHESIA GROUP, P.A. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address PO BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2023-06-29
Name of individual signing RICHARD A. MCCLUNEY, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2021 640503363 2022-06-24 TUPELO ANESTHESIA GROUP, P.A. 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address PO BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2022-06-24
Name of individual signing RICHARD A. MCCLUNEY, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2020 640503363 2021-06-07 TUPELO ANESTHESIA GROUP, P.A. 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address PO BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2021-06-07
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2019 640503363 2020-05-07 TUPELO ANESTHESIA GROUP, P.A. 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address PO BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2020-05-07
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2018 640503363 2019-04-29 TUPELO ANESTHESIA GROUP, P.A. 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address PO BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2019-04-29
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-04-29
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2017 640503363 2018-04-27 TUPELO ANESTHESIA GROUP, P.A. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P.O. BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2018-04-27
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2016 640503363 2017-04-13 TUPELO ANESTHESIA GROUP, P.A. 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P.O. BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2017-04-13
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P. A. 401(K) PROFIT SHARING PLAN AND TRUST 2015 640503363 2016-05-09 TUPELO ANESTHESIA GROUP, P.A. 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P.O. BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2016-05-09
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
TUPELO ANESTHESIA GROUP, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2014 640503363 2015-05-27 TUPELO ANESTHESIA GROUP, P.A. 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P.O. BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2015-05-27
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/25/20140725095712P040055221239001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P.O. BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2014-07-25
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-25
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/16/20130716154444P030109956165001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P.O. BOX 3294, TUPELO, MS, 38803

Signature of
Role Plan administrator
Date 2013-07-16
Name of individual signing JOHN H. DOUGLAS, III, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/17/20120717155342P030017171600001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1971-06-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P.O. BOX 3294, TUPELO, MS, 38803

Plan administrator’s name and address
Administrator’s EIN 640503363
Plan administrator’s name TUPELO ANESTHESIA GROUP, P.A.
Plan administrator’s address P.O. BOX 3294, TUPELO, MS, 38803
Administrator’s telephone number 6623774394

Signature of
Role Plan administrator
Date 2012-07-17
Name of individual signing JOHN H. DOUGLAS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/09/22/20110922154648P030628648960001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1971-07-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P. O. BOX 3294, TUPELO, MS, 38803

Plan administrator’s name and address
Administrator’s EIN 640503363
Plan administrator’s name TUPELO ANESTHESIA GROUP, P.A.
Plan administrator’s address P. O. BOX 3294, TUPELO, MS, 38803
Administrator’s telephone number 6623774394

Signature of
Role Plan administrator
Date 2011-09-22
Name of individual signing JOHN H. DOUGLAS, III
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-22
Name of individual signing JOHN H. DOUGLAS, III
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/22/20100922121649P070000765283001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1971-07-29
Business code 621111
Sponsor’s telephone number 6623774394
Plan sponsor’s address P. O. BOX 3294, TUPELO, MS, 38803

Plan administrator’s name and address
Administrator’s EIN 640503363
Plan administrator’s name TUPELO ANESTHESIA GROUP, P.A.
Plan administrator’s address P. O. BOX 3294, TUPELO, MS, 38803
Administrator’s telephone number 6623774394

Signature of
Role Plan administrator
Date 2010-09-22
Name of individual signing JOHN H. DOUGLAS, III
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-22
Name of individual signing JOHN H. DOUGLAS, III
Valid signature Filed with authorized/valid electronic signature

Director

Name Role Address
Clayton W. Cordell, III Director P.O. Box 3294, Tupelo, MS 38803-3294
Steven L. Brister Director P.O. Box 3294, Tupelo, MS 38803
Bradley G. Womack Director P.O. Box 3294, Tupelo, MS 38803
Matthew M. Myers Director P.O. Box 3294, Tupelo, MS 38803
Peggy Boles MD Director P.O. Box 3294, Tupelo, MS 38803
Molli L. Floyd MD Director P.O. Box 3294, Tupelo, MS 38803
David K. Monaghan MD Director 118 Rock Creek Drive, Tupelo, MS 38801
Richard A. McCluney, Director P.O. Box 3294, Tupelo, MS 38803-3294
Chester W. Masterson, III Director P. O. Box 3294, Tupelo, MS 38803

President

Name Role Address
Clayton W. Cordell, III President P.O. Box 3294, Tupelo, MS 38803-3294

Vice President

Name Role Address
Steven L. Brister Vice President P.O. Box 3294, Tupelo, MS 38803
Bradley G. Womack Vice President P.O. Box 3294, Tupelo, MS 38803
Matthew M. Myers Vice President P.O. Box 3294, Tupelo, MS 38803
Peggy Boles MD Vice President P.O. Box 3294, Tupelo, MS 38803
Molli L. Floyd MD Vice President P.O. Box 3294, Tupelo, MS 38803
Chester W. Masterson, III Vice President P. O. Box 3294, Tupelo, MS 38803

Treasurer

Name Role Address
David K. Monaghan MD Treasurer 118 Rock Creek Drive, Tupelo, MS 38801

Secretary

Name Role Address
Richard A. McCluney, Secretary P.O. Box 3294, Tupelo, MS 38803-3294

Agent

Name Role Address
Richard A. McCluney Agent 830 South Gloster Street, 2nd Floor, Tupelo, MS 38801

Filings

Type Status Filed Date Description
Annual Report Filed 2025-01-24 Annual Report For TUPELO ANESTHESIA GROUP, P. A.
Annual Report Filed 2024-03-22 Annual Report For TUPELO ANESTHESIA GROUP, P. A.
Amendment Form Filed 2023-03-01 Amendment For TUPELO ANESTHESIA GROUP, P. A.
Annual Report Filed 2023-01-05 Annual Report For TUPELO ANESTHESIA GROUP, P. A.
Annual Report Filed 2022-02-01 Annual Report For TUPELO ANESTHESIA GROUP, P. A.
Annual Report Filed 2021-01-15 Annual Report For TUPELO ANESTHESIA GROUP, P. A.
Annual Report Filed 2020-01-15 Annual Report For TUPELO ANESTHESIA GROUP, P. A.
Annual Report Filed 2019-01-18 Annual Report For TUPELO ANESTHESIA GROUP, P. A.
Annual Report Filed 2018-01-15 Annual Report For TUPELO ANESTHESIA GROUP, P. A.
Annual Report Filed 2017-01-13 Annual Report For TUPELO ANESTHESIA GROUP, P. A.

Related by officers

Richard A. McCluney

Kempton Enterprises, LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Mississippi Secretary of State

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