FORM 1023-EZ for MOBILE DIAGNOSTIC LABORATORY
| Field | Data |
|---|---|
| EIN | 85-2470371 |
| Case Number | EO-2020252-000242 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | MOBILE DIAGNOSTIC LABORATORY |
| Organization’s Mailing Address | PO BOX 783 |
| City | PINE BLUFF |
| State | AR |
| ZIP | 71611-7833 |
| Accounting period End | 12 |
| Primary contact name | JOSEPH H TROTTER MD |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JOSEPH TROTTER
DIRECTOR
1309 BOSTON
PINE BLUFF AR 71601
Officer/Director/Trustee Two
TOI GRIMM
VICE PRESIDENT
HWY 63 SOUTH
PINE BLUFF AR 71603-6578
Officer/Director/Trustee Three
PAT JENKINS
SECRETARY
3004 KENDYL
PINE BLUFF AR 71603-4788
Officer/Director/Trustee Four
GLORIA BROWN
TREASURE
8219 HWY 63 SOUTH
PINE BLUFF AR 71603-4788
Officer/Director/Trustee Five
TAMMIE HALL
BOARD MEMBER
36 STONERIDGE DRIVE
PINE BLUFF AR 71603-8501
| Organization’s website | N/A |
|---|---|
| Organization’s email | MOBILELAB1309@ATT.NET |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 8/6/2020 |
| Organization Incorporation State | AR |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E21 - Community Health Systems |
| Organization’s purpose | Charitable: Yes Religious: No Educational: Yes Scientific: Yes Literary: Yes 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 | JOSEPH TROTTER |
| Signature Title | DIRECTOR |
| Signature Date | 9/3/2020 |
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