FORM 1023-EZ for EMERY BOCK MEMORIAL SCHOLARSHIP FUND

Field Data
EIN 81-4966848
Case Number EO-2017017-000494
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMERY BOCK MEMORIAL SCHOLARSHIP FUND
Organization’s Mailing Address 617 FALLEN TIMBER LN
City MASCOUTAH
State IL
ZIP 62258
Accounting period End 12
Primary contact name MICHAEL HOLT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREA HOLT
TRUSTEE
617 FALLEN TIMBER LN
MASCOUTAH IL 62258

Officer/Director/Trustee Two

MICHAEL HOLT
TRUSTEE
617 FALLEN TIMBER LN
MASCOUTAH IL 62258

Officer/Director/Trustee Three

LISA HEMRICH
TRUSTEE
3535 NORTH WAKEFIELD
NOBLE IL 62868

Officer/Director/Trustee Four

HANNAH BOCK
TRUSTEE
617 FALLEN TIMBER LN
MASCOUTAH IL 62258

Organization’s website
Organization’s email
Organization Incorporated
Organization trust Yes
Necessary Organizing Documents Yes
Organization Incorporation Date 1/13/2017
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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
Signature Title
Signature Date

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