FORM 1023-EZ for SOUTHERN DERMATOLOGY CONSORTIUM

Field Data
EIN 86-3137559
Case Number EO-2021118-000297
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SOUTHERN DERMATOLOGY CONSORTIUM
Organization’s Mailing Address 7831 PARK LANE 115A
City DALLAS
State TX
ZIP 75225
Accounting period End 12
Primary contact name DAN DUNAWAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAN DUNAWAY
TRUSTEE
7831 PARK LANE 115A
DALLAS TX 75225

Officer/Director/Trustee Two

ROBERT BRODELL
TRUSTEE
2500 NORTH STATE STREET
JACKSON MS 79216

Officer/Director/Trustee Three

TEJESH PATEL
TRUSTEE
930 MADISON AVENUE
MEMPHIS TN 38163

Officer/Director/Trustee Four

SARA SHALIN
TRUSTEE
4301 WEST MARKHAM
LITTLE ROCK AR 72205

Organization’s website
Organization’s email DUNAWAYMEMPHIS@AOL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2021
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H80 - Specifically Named Diseases Research
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: Yes
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DAN DUNAWAY
Signature Title TRUSTEE
Signature Date 4/26/2021

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