FORM 1023-EZ for PROJECT DENTAL ACCESS INC

Field Data
EIN 81-5192331
Case Number EO-2018193-000326
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PROJECT DENTAL ACCESS INC
Organization’s Mailing Address 9329 MIDDLEBROOK PIKE
City KNOXVILLE
State TN
ZIP 37931-4704
Accounting period End 6
Primary contact name DEBRA HALL FISHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEBRA H FISHER RDH BS RDA
EXECUTIVE DIRECTOR
9329 MIDDLEBROOK PIKE
KNOXVILLE TN 37931-4704

Officer/Director/Trustee Two

PAUL D PHILLIPS BSN MBA
COO/CHAIRMAN
815 ECHO HOLLOW ROAD
LENOIR CITY TN 37771-7327

Officer/Director/Trustee Three

LYDIA MCDONALD EDDMA
DIRECTOR OF DEV/STRATEGIC INITIATIV
2 HENDRICKSON LANE
GREENBRIAR AR 72058

Officer/Director/Trustee Four

TERRYE GUTHE RDA CST
MANAGING DIRECTOR
216 SUBURBAN ROAD
KNOXVILLE TN 37923

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/31/16
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
Donation of funds Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DEBRA H FISHER RDH BS RDA
Signature Title EXECUTIVE DIRECTOR
Signature Date 7/10/18

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