FORM 1023-EZ for VIRGINIA INSTITUTE OF RECONSTRUCTIVE SURGERY

Field Data
EIN 82-3922783
Case Number EO-2018010-000204
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name VIRGINIA INSTITUTE OF RECONSTRUCTIVE SURGERY
Organization’s Mailing Address 1925 GLENN MITCHELL DR STE 206
City VIRGINIA BCH
State VA
ZIP 23456
Accounting period End 12
Primary contact name JOHN S MANCOLL MD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN MANCOLL
PRESIDENT
1925 GLEN MITCHELL DR STE 206
VIRGINIA BEACH VA 23456

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/29/17
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H9B - Surgery Research
Organization’s purpose Charitable: Yes
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 JOHN MANCOLL
Signature Title PRESIDENT
Signature Date 1/8/18

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