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BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.

Company Details

Name: BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.
Jurisdiction: MISSISSIPPI
Business Type: Non Profit Corporation
Status: Good Standing
Effective Date: 30 Dec 1981 (43 years ago)
Business ID: 500329
ZIP code: 38829
County: Prentiss
State of Incorporation: MISSISSIPPI
Principal Office Address: SECOND & WASHINGTON STREETSBOONEVILLE, MS 38829
Fictitious names: Baptist Booneville Outpatient Pharmacy

Agent

Name Role Address
C. T. CORPORATION SYSTEM Agent 645 LAKELAND EAST DRIVE STE 101, FLOWOOD, MS 39232

Incorporator

Name Role Address
H T CONLEY Incorporator P O BOX 431, CORINTH, MS
THOMAS D KEENUM SR Incorporator P O BOX 422, P O BOX 422, BOONEVILLE, MS
WILLIAM HALL PRESTON JR Incorporator 402 WEST CHURCH ST, CORINTH, MS

Secretary

Name Role Address
Gregory M Duckett Secretary 350 N. Humphreys Blvd, Memphis, TN 38120

Director

Name Role Address
John Stanford MD Director 350 N. Humphreys Blvd., Memphis, TN 38120
Travis Childers Director 350 N. Humphreys Blvd., Memphis, TN 38120
Thomas Floyd Jr Director 350 N. Humphreys Blvd., Memphis, TN 38120
Robert Griffin Director 350 N. Humphreys Blvd., Memphis, TN 38120
Solomon Willie Shinault Director 350 N Humphreys Blvd, Memphis, TN 38120

Chairman

Name Role Address
John Stanford MD Chairman 350 N. Humphreys Blvd., Memphis, TN 38120

President

Name Role Address
Jason M Little President 350 N. Humphreys Blvd, Memphis, TN 38120

Vice President

Name Role Address
Chris Anderson Vice President 350 N. Humphreys Blvd, Memphis, TN 38120

Filings

Type Status Filed Date Description
Non-Profit Annual Report Filed 2025-01-08 Annual Report For BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.
Fictitious Name Registration Filed 2024-12-30 Fictitious Name Registration For BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.
Amendment Form Filed 2023-03-31 Amendment For BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.
Amendment Form Filed 2021-09-15 Amendment For BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.
Non-Profit Status Report Filed 2021-01-13 Status Report For BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.
Amendment Form Filed 2018-11-30 Amendment For BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.
Formation Form Filed 2011-05-06 Formation
Amendment Form Filed 2003-02-14 Amendment
Amendment Form Filed 1997-09-29 Amendment
Amendment Form Filed 1989-11-10 Amendment

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
345908172 0419400 2022-04-20 100 HOSPITAL STREET, BOONEVILLE, MS, 38829
Inspection Type FollowUp
Scope Partial
Safety/Health Health
Close Conference 2022-04-20
Emphasis N: COVID-19
Case Closed 2022-04-21

Related Activity

Type Inspection
Activity Nr 1557987
Health Yes
345579874 0419400 2021-10-13 100 HOSPITAL STREET, BOONEVILLE, MS, 38829
Inspection Type Planned
Scope Complete
Safety/Health Health
Close Conference 2021-10-14
Emphasis N: COVID-19, P: COVID-19
Case Closed 2022-04-08

Violation Items

Citation ID 01001A
Citaton Type Serious
Standard Cited 19100502 F02 I
Issuance Date 2022-03-31
Current Penalty 5283.6
Initial Penalty 8806.0
Final Order 2022-04-08
Nr Instances 1
Nr Exposed 3
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.502(f)(2)(i):The employer did not ensure that a respirator was used in accordance with 29 CFR � 1910.134 when employees have exposure to a person with suspected or confirmed COVID-19. At Baptist Memorial Hospital - Booneville, Inc., 100 Hospital Street, Booneville, MS 38019: a.) On or about October 13, 2021, the employer failed to ensure respirators were used in accordance with 29 CFR � 1910.134, when employees were exposed while providing care to suspected and confirmed COVID-19 patients.
Citation ID 01001B
Citaton Type Serious
Standard Cited 19100134 F02
Issuance Date 2022-03-31
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2022-04-08
Nr Instances 1
Nr Exposed 3
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.134(f)(2):Employee(s) using tight-fitting facepiece respirators were not fit tested prior to initial use of the respirator or annually thereafter: At Baptist Memorial Hospital - Booneville, Inc., 100 Hospital Street, Booneville, MS 38019: a.) On or about October 13, 2021, the employer failed to provide an initial or annual fit test to all employees who wore Halyard Fluidshield N95 respirators. The employer required employees to wear N95 filtering facepiece respirators to protect against the SARS-CoV-2 virus while providing care to suspected and confirmed COVID-19 patients.
Citation ID 02001
Citaton Type Other
Standard Cited 19100502 Q02 II A
Issuance Date 2022-03-31
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2022-04-08
Nr Instances 1
Nr Exposed 1
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.502(q)(2)(ii)(A):The COVID-19 log did not contain the employee's occupation. At Baptist Memorial Hospital - Booneville, Inc., 100 Hospital Street, Booneville, MS 38019: a.) On or about October 13, 2021, the employer failed to ensure the COVID-19 log contained the employee's occupation.

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
64-0663760 Corporation Unconditional Exemption 100 HOSPITAL ST, BOONEVILLE, MS, 38829-3354 1983-04
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-09
Asset 10,000,000 to 49,999,999
Income 10,000,000 to 49,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Sep
Asset Amount 13119266
Income Amount 24198352
Form 990 Revenue Amount 24108650
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data

Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)

Organization Name BAPTIST MEMORIAL HOSPITAL-BOONEVILLE INC
EIN 64-0663760
Tax Period 202109
Filing Type E
Return Type 990
File View File
Organization Name BAPTIST MEMORIAL HOSPITAL-BOONEVILLE INC
EIN 64-0663760
Tax Period 202009
Filing Type E
Return Type 990
File View File
Organization Name BAPTIST MEMORIAL HOSPITAL-BOONEVILLE INC
EIN 64-0663760
Tax Period 201909
Filing Type E
Return Type 990
File View File
Organization Name BAPTIST MEMORIAL HOSPITAL-BOONEVILLE INC
EIN 64-0663760
Tax Period 201809
Filing Type E
Return Type 990
File View File
Organization Name BAPTIST MEMORIAL HOSPITAL BOONEVILLEINC
EIN 64-0663760
Tax Period 201709
Filing Type E
Return Type 990
File View File
Organization Name BAPTIST MEMORIAL HOSPITAL-BOONEVILLE INC
EIN 64-0663760
Tax Period 201609
Filing Type E
Return Type 990
File View File
Organization Name BAPTIST MEMORIAL HOSPITAL-BOONEVILLEINC
EIN 64-0663760
Tax Period 201509
Filing Type E
Return Type 990
File View File

Date of last update: 12 Mar 2025

Sources: Mississippi Secretary of State