FORM 1023-EZ for MID-SOUTH EDUCATIONAL RESEARCH ASSOCIATION

Field Data
EIN 64-0586207
Case Number EO-2016202-000336
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MID-SOUTH EDUCATIONAL RESEARCH ASSOCIATION
Organization’s Mailing Address 1094 SPANISH MISSION TRAIL
City LAKE CHARLES
State LA
ZIP 70605
Accounting period End 6
Primary contact name DUSTIN HEBERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DUSTIN HEBERT
PRESIDENT
1094 SPANISH MISSION TRAIL
LAKE CHARLES LA 70605

Officer/Director/Trustee Two

GAIL HUGHES
PAST PRESIDENT
2801 S UNIVERSITY AVE
LITTLE ROCK AR 72204

Officer/Director/Trustee Three

FRANZ RENEAU
PRESIDENT-ELECT
659 ARDELIA CT
TALLAHASSEE FL 32307

Officer/Director/Trustee Four

SHANNON CHIASSON
SECRETARY
312 WINDSOR DR
THIBODAUX LA 70301

Officer/Director/Trustee Five

CLIFF HOFWOLT
EXECUTIVE DIRECTOR
230 APPLETON PL
NASHVILLE TN 37203

Organization’s website HTTP://WWW.MSERA.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/5/1972
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B03 - Professional Societies, Associations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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