FORM 1023-EZ for HEMLOCK SYSTEMS INC

Field Data
EIN 86-2398053
Case Number EO-2021100-000340
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEMLOCK SYSTEMS INC
Organization’s Mailing Address 3219 E CAMELBACK RD NO 361
City PHOENIX
State AZ
ZIP 85018
Accounting period End 12
Primary contact name LAWRENCE ROSKY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAWRENCE ROSKY
PRESIDENT
3219 E CAMELBACK RD NO 361
PHOENIX AZ 85018

Officer/Director/Trustee Two

JON PITT
VICE PRESIDENT
4232 N 35TH STREET
PHOENIX AZ 85018

Officer/Director/Trustee Three

MARY HAGEN
TREASURER
15220 N 75TH ST
SCOTTSDALE AZ 85260

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/23/2020
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I01 - Alliance/Advocacy Organizations
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LAWRENCE ROSKY
Signature Title PRESIDENT
Signature Date 3/24/2021

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