FORM 1023-EZ for ORGANIZATION OF DATUM CLINICAL RESEARCH

Field Data
EIN 81-4057095
Case Number EO-2017205-000206
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ORGANIZATION OF DATUM CLINICAL RESEARCH
Organization’s Mailing Address 11220 ELM LANE STE 200
City CHARLOTTE
State NC
ZIP 28277
Accounting period End 12
Primary contact name JESSICA SPIVEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JESSICA SPIVEY
PRESIDENT
11220 ELM LANE STE 200
CHARLOTTE NC 28277

Officer/Director/Trustee Two

MICHEAL DYER
TREASURER
11220 ELM LANE STE 200
CHARLOTTE NC 28277

Officer/Director/Trustee Three

STACEY GIBSON
SECRETARY
11220 ELM LANE STE 200
CHARLOTTE NC 28277

Organization’s website WWW.DATUMCR.COM
Organization’s email JSPIVEY@ONSITECLINICAL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/21/2017
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code U02 - Management & Technical Assistance
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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
Signature Title
Signature Date

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