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  5. BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.

BAPTIST MEMORIAL HOSPITAL - BOONEVILLE, INC.

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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

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
S5EFFNJV3PN9
CAGE Code:
8SL47
UEI Expiration Date:
2025-09-04

Business Information

Activation Date:
2024-09-05
Initial Registration Date:
2020-09-25

National Provider Identifier

NPI Number:
1730796483
Certification Date:
2020-09-30
Link:
View on NPI website

Authorized Person:

Name:
GREGORY M DUCKETT
Role:
SR VP/ CLO
Phone:
9012275233

Taxonomy:

Selected Taxonomy:
3336C0003X - Community/Retail Pharmacy
Is Primary:
Yes

Contacts:

Phone:
+1 901-227-4133
Fax:
9012275004
Phone:
+1 662-720-5250
Fax:
6627205275

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 Summary

Date:
2022-04-20
Type:
FollowUp
Address:
100 HOSPITAL STREET, BOONEVILLE, MS, 38829
Safety Health:
Health
Scope:
Partial

Inspection Summary

Date:
2021-10-13
Type:
Planned
Address:
100 HOSPITAL STREET, BOONEVILLE, MS, 38829
Safety Health:
Health
Scope:
Complete

Tax Exempt

Employer Identification Number (EIN) :
64-0663760
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)
Ruling Date:
1983-04
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

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John Stanford MD

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Jason M Little

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Chris Anderson

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Date of last update: 19 Apr 2025

Sources: Mississippi Secretary of State

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