FORM 1023-EZ for TEXAS SOCIETY OF DENTIST ANESTHESIOLOGISTS

Field Data
EIN 82-4672226
Case Number EO-2018095-000320
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TEXAS SOCIETY OF DENTIST ANESTHESIOLOGISTS
Organization’s Mailing Address 3401 ROYAL VISTA BLVD A100
City ROUND ROCK
State TX
ZIP 78681
Accounting period End 12
Primary contact name TIMOTHY ORR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAROM HEATON
PRESIDENT
3401 ROYAL VISTA BLVD A100
ROUND ROCK TX 78681

Officer/Director/Trustee Two

HUNTER STEWART
VICE-PRESIDENT
3401 ROYAL VISTA BLVD A100
ROUND ROCK TX 78681

Officer/Director/Trustee Three

LUCY PARK
TREASURER
3401 ROYAL VISTA BLVD A100
ROUND ROCK TX 78681

Officer/Director/Trustee Four

LISA GORTIARI
SECRETARY
3401 ROYAL VISTA BLVD A100
ROUND ROCK TX 78681

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/12/18
Organization Incorporation State TX
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 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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JAROM HEATON
Signature Title PRESIDENT
Signature Date 3/21/18

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