Form990-EZ
Department of the Treasury
Internal Revenue Service
Short Form
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)
bullet Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions).
All other organizations with gross receipts less than $200,000 and total assets less than $500,000 at the end of the year may use this form.
bulletThe organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-1150
2011
Open to Public
Inspection
A
For the 2011 calendar year, or tax year beginning 07-01-2011, and ending 06-30-2012
B
Check if applicable:
C Name of organization
LIONS CLUB OF SEYMOUR WISCONSIN INC
 
Number and street (or P. O. box, if mail is not delivered to street address)147 W WISCONSIN ST
  Room/suite
City or town, state or country, and ZIP + 4 SEYMOUR, WI54165
D Employer identification number

23-7426786
E Telephone number

F Group Exemption
Number. . bullet0239
G Accounting method: Other (specify) bullet   H Check bulletI Website:bullet   J Tax-Exempt status(check only one)—( 4) bullet(insert no.) or
K Check bullet A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return.
L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts; If gross receipts are $200,000 or more, or if total assets (Part II, line 25, column (B) below) are $500,000 or more,file Form 990 instead of Form 990-EZ........... bullet $ 51,842
Part IRevenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.)Check if the organization used Schedule O to respond to any question in this Part I...........
VerticalRevenue 1 Contributions, gifts, grants, and similar amounts received............... 1 4,962
2 Program service revenue including government fees and contracts ............ 2  
3 Membership dues and assessments...................... 3  
4 Investment income........................... 4 1,859
5a Gross amount from sale of assets other than inventory........ 5a  
b Less: cost or other basis and sales expenses........... 5b  
c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ...... 5c  
6 Gaming and fundraising events
a Gross income from gaming (attach Schedule G if greater than $15,000) . 6a 25,000
b Gross income from fundraising events (not including $ 3,662 of contributions
from fundraising events reported on line 1) (attach Schedule G if the Click to see attachment
sum of such gross income and contributions exceeds $15,000) 6b 19,867
c Less: direct expenses from gaming and fundraising events....... 6c 19,862
d Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c) 6d 25,005
7a Gross sales of inventory, less returns and allowances........ 7a  
b Less: cost of goods sold................. 7b  
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) ......... 7c  
8 Other revenue (describe in Schedule O) ..................... 8 154
9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8................. 9 31,980
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) ................. 10 22,886
11 Benefits paid to or for members........................ 11  
12 Salaries, other compensation, and employee benefits................ 12  
13 Professional fees and other payments to independent contractors............ 13 760
14 Occupancy, rent, utilities, and maintenance................... 14  
15 Printing, publications, postage, and shipping................... 15 156
16 Other expenses (describe in Schedule O) .................... 16 4,678
17 Total expenses. Add lines 10 through 16 .................... 17 28,480
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9)............ 18 3,500
19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
end-of-year figure reported on prior year’s return)................ 19 40,089
20 Other changes in net assets or fund balances (explain in Schedule O) .......... 20  
21 Net assets or fund balances at end of year. Combine lines 18 through 20.........Bullet 21 43,589
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I Form 990-EZ (2011)
Form 990-EZ (2011)
Page 2
Part IIBalance Sheets (see the instructions for Part II.)Check if the organization used Schedule O to respond to any question in this Part II.............

(See the instructions for Part II.)(A) Beginning of year(B) End of year
22Cash, savings, and investments................
40,089
22
43,589
23Land and buildings....................
0
23
0
24Other assets (describe in Schedule O) ..........
0
24
0
25Total assets......................
40,089
25
43,589
26
Total liabilities (describe in Schedule O) .............
0
26
0
27Net assets or fund balances (line 27 of column (B) must agree with line 21)..
40,089
27
43,589
Part IIIStatement of Program Service Accomplishments (see the instructions for Part III.) Check if the organization used Schedule O to respond to any question in this Part III . Expenses
(Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)
What is the organization's primary exempt purpose? SERVE BY REACHING TOUCHING IMPROV LIVES
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 CONTRIBUTIONS TO WI LIONS FOUNDATION HELP MAINTAIN CAMP FOR BLIND CHILDRENFUND ENDOWMENTVISION SCREENINGEYEGLASS RECYCLING CENTERHEARING PROJECTSTHOUSANDS OF PEOPLE BENEFIT
(Grants $ 6,500) If this amount includes foreign grants, check here ...MediumBullet		 28a 6,500
29 RAFFLE BENEFIT FAMILY OF CANCER PATIENT WITH MEDICAL EXPENSES REPORTING IS ON CASH BASIS
(Grants $ 8,000) If this amount includes foreign grants, check here ...MediumBullet		 29a 11,500
30 2 SCHOLARSHIPS OF 1500 EACH ARE AWARDED ANNUALLY TO 2 SENIORS OF SEYMOUR HIGH SCHOOL WHO HAVE EXCELLED ATHLETICALLY AND SCHOLASTICALLYANNUAL BANQUET HONORING ALL HIGH SCHOOL AT
(Grants $ 3,000) If this amount includes foreign grants, check here ...MediumBullet		 30a 3,000
Other program services
(Grants $ 4,317) If this amount includes foreign grants, check here ...MediumBullet		 4,317
31 Other program services (describe in Schedule O) ..................
(Grants $   ) If this amount includes foreign grants, check here...MediumBullet		 31a
32 Total program service expenses (add lines 28a through 31a)..............bullet 32 25,317
Part IV List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (see the instructions for Part IV.)Check if the organization used Schedule O to respond to any question in this Part IV..........
(a) Name and title (b) Average
hours per week
devoted to position		 (c)Reportable compensation
(Forms W-2/1099-MISC)
(if not paid, enter -0-) 		(d) Health benefits, contributions to employee benefit plans,
and deferred compensation		 (e) Estimated amount
of other compensation
JOHN NAGEL
W3188 HIGH ST
SEYMOUR,WI54165
 PRESIDENT5 0 0 0
JOHN SELMER
722 BROOKWOOD DR
SEYMOUR,WI54165
 VICE PRES5 0 0 0
JOEL WALTERS
744 GREENFIELD CT
SEYMOUR,WI54165
 SECRETARY5 0 0 0
RANDALL REED
N7034 BALLARD RD
SEYMOUR,WI54165
 TREASURER5 0 0 0
Form 990-EZ (2011)
Form 990-EZ (2011)
Page 3
Part VOther Information(Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O ...................
33
 
No
34
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization’s name. Otherwise, explain the changeon Schedule O (see instructions). ..........................
34
 
No
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? ............
35a
 
No
b
If ‘Yes’ to line 35a, has the organization filed a Form 990-T for the year? If ‘No,’ provide an explanation in Schedule O.
35b
 
 
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III.
35c
 
No
36
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If “Yes,” complete applicable parts of Schedule N ................
36
 
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions. bullet
37a
 
b
Did the organization file Form 1120-POL for this year?...................
37b
 
No
38a
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?..
38a
 
No
b
If “Yes,” complete Schedule L, Part II and enter the total amount involved .
38b
 
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9.......
39a
 
b
Gross receipts, included on line 9, for public use of club facilities.....
39b
 
40a
Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911 bullet   ; section 4912 bullet   ; section 4955 bullet  
b
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefittransaction during the year or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I. ......
40b
 
No
c
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958...bullet  
d
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization....................bullet  
e
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T. ......................
40e
 
No
41List the states with which a copy of this return is filed. bullet
42aThe organization's books are in care of bulletRANDALL REED Telephone no. bullet (920) 833-2132
Located at bulletN7034 BALLARD RD
SEYMOUR,WI ZIP + 4bullet54165
b
At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
Yes
No
42b
 
No
If “Yes,” enter the name of the foreign country: bullet  
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
c
At any time during the calendar year, did the organization maintain an office outside the U.S.?
42c
 
No
If “Yes,” enter the name of the foreign country: bullet  
43.......bullet
and enter the amount of tax-exempt interest received or accrued during the tax year....bullet43
 
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of
Form 990-EZ.................................
44a
 
No
b
Did the organization operate one or more hospital facilities during the year? If ‘Yes,’ Form 990 must be completedinstead of Form990-EZ.............................
44b
 
No
c
Did the organization receive any payments for indoor tanning services during the year?.........
44c
 
No
d
If 'Yes' to line 44c, has the organization filed a Form 720 to report these payments? If ‘No,’ provide an explanationin Schedule O................................
44d
 
 
45a
Did the organization have a controlled entity within the meaning of
section 512(b)(13)?............................
45a
 
No
45b
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of Form990-EZ (see instructions).....................
45b
 
No
Form 990-EZ (2011)
Form 990-EZ (2011)
Page 4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition tocandidates for public office? If “Yes,” complete Schedule C, Part I. ..............
46
 
No
Part VI
Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b and 52. Check if the organization used Schedule O to respond to any question in this Part VI ...........
Yes
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .......................
47
 
 
48
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ....
48
 
 
49a
Did the organization make any transfers to an exempt non-charitable related organization?......
49a
 
 
b
If "Yes," was the related organization a section 527 organization?................
49b
 
 
50
Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and title of each employee paid more than $100,000 (b) Average
hours per week
devoted to position		 (c) Reportable compensation
(Forms W-2/1099-MISC) 		(d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation
 
f
Total number of other employees paid over $100,000 .................bullet  

51
Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and address of each independent contractor paid more than $100,000 (b) Type of service (c) Compensation
 
d
Total number of other independent contractors each receiving over $100,000..........bullet  
52
Did the organization complete Schedule A? NOTE:All Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A .....................
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
Form 990-EZ (2011)

Additional Data


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Form 990-EZ, Special Condition Description:
Special Condition Description
SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
LIONS CLUB OF SEYMOUR WISCONSIN INC
 
Employer identification number

23-7426786
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
WI
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

ROSE SALE
(event type) 		(b) Event #2

FAIR BOOTH
(event type) 		(c) Other Events

  
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 7,825 5,695   13,520
2 Less: Charitable
contributions . . . 		       
3 Gross income (line 1
minus line 2) . . . 		7,825 5,695   13,520
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages . .        
8 Entertainment . . .        
9 Other direct expenses . 3,728     3,728
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 3,728
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow 9,792
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .     25,000 25,000
VerticalDirectExpenses 2 Cash prizes . . . .     11,500 11,500
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
100.000 %
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow 11,500
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow 13,500
9
Enter the state(s) in which the organization operates gaming activities: WI
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
RANDALL REED
Address right arrow
N7034 BALLARD RD
SEYMOUR,WI54165
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$ 11,500
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2011
Additional Data


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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
LIONS CLUB OF SEYMOUR WISCONSIN INC
 
Employer identification number

23-7426786
Identifier Return Reference Explanation
01. Description of other revenue (Part I, line 8)   DESCRIPTION AMOUNT CAMP TRIP 154
02. List of grants and similar amounts paid (Part I, line 10)   ACTIVITY SCHOLARSHIP GRANTEE TROY ROTTIER SEYMOUR WI 54165 RELATIONSHIP NONE AMOUNT 1500 ACTIVITY HANDICAP ACCESS TO RECREATION GRANTEE CHALLENGE THE OUTDOORS INC ADDRESS N8154 CTY HWY M SHIOCTON WI 54170 RELATIONSHIP NONE AMOUNT 200 ACTIVITY FOOD TO NEEDY GRANTEE SEYMOUR FOOD PANTRY ADDRESS 328 N MAIN ST SEYMOUR WI 54165 RELATIONSHIP NONE AMOUNT 300 ACTIVITY FOODCLOTHING GRANTEE SEYMOUR SALVATION ARMY ADDRESS 328 N MAIN ST SEYMOUR WI 54165 RELATIONSHIP NONE AMOUNT 300 ACTIVITY FOODCLOTHING GRANTEE ST VINCENT DEPAUL SOCIETY ADDRESS 928 S MAIN ST SEYMOUR WI 54165 RELATIONSHIP NONE AMOUNT 300 ACTIVITY SCHOLARSHIP GRANTEE JILL GORGES SEYMOUR WI 54165 RELATIONSHIP NONE AMOUNT 1500 ACTIVITY SPECIAL NEEDS CHILDREN GRANTEE WISCONSIN LIONS FOUNDATION INC ADDRESS 3834 CTY RD A ROSHOLT WI 54473 RELATIONSHIP LION ORG AMOUNT 6500 ACTIVITY DONATION TO FAMILY MEDICAL EXPENSES GRANTEE DOREEN OSSMANN SEYMOUR WI 54165 RELATIONSHIP NONE AMOUNT 8000 ACTIVITY LIONS CLUB INTERNATIONAL DUES GRANTEE LION CLUB INTERNATIONAL ADDRESS 300 W 22ND ST OAK BROOK IL 60523 RELATIONSHIP MAIN ORG AMOUNT 1946 ACTIVITY DUES TO WISCONSIN LIONS GRANTEE WISCONSIN LIONS ADDRESS 2809 POST RD STEVENS POINT WI 54481 RELATIONSHIP MAIN ORG AMOUNT 771 ACTIVITY ALCOHOL AND DRUG ABUSE PREVENTION GRANTEE NEW BEAT THE HEAT SEYMOUR CHPTR ADDRESS 10 CIRCLE DR SEYMOUR WI 54165 RELATIONSHIP NONE AMOUNT 500 ACTIVITY HELP DISABLED IN COMMUNITY GRANTEE LOCAL RESIDENT SEYMOUR WI 54165 RELATIONSHIP NONE AMOUNT 924 ACTIVITY LIONS CAMP SPONSORSHIP FOR DISABLED GRANTEE JOEL WALTERS FAMILY SEYMOUR WI 54165 RELATIONSHIP OFFICERS CHILD AMOUNT 145
03. Description of other expenses (Part I, line 16)   DESCRIPTION AMOUNT MEETINGSSPEAKERS 2955 LICENSE RENEWALS 50 CORPORATE REPORT 10 CLUB AWARDSMEMBER SUPPLIES 1184 SUPPLIES 166 PARK MAINTENANCE SUPPLIES 313
04. Other program services (Part III, line 31)   990-EZ PART III LINE 31- OTHER PROGRAM SERVICES HANDICAP ACCESS TO CHILDREN-CHALLENGE THE OUTDOORS INC-DONATION MADE 200 FOOD TO NEEDY -SEYMOUR FOOD PANTRY -DONATION MADE 300 FOODCLOTHING TO NEEDY -SEYMOUR SALVATION ARMY -DONATION MADE 300 FOODCLOTHING TO NEEDY -ST VINCENT DEPAUL SOCIETY -DONATION MADE 300 DUES INTL LION CLUB -LION CLUB INTERNATIONAL -DUES 1946 DUES WISCONSIN LIONS -STATE LIONS CLUB -DUES 771 ALCOHOLDRUG PREVENTION -SEYMOUR COMMUNITY SCHOOL -DONATION 500 SCHEDULE G-GAMING THE ORGANIZATION CONDUCTS 1 RAFFLE PER FISCAL YEARTHE REPORTING ON THIS FORM INCLUDES THE RECEIPTS FROM THE RAFFLE AND THE PAYMENTS MADE REPORTING IS ON A CASH BASIS THE BREAKDOWN OF THE RAFFLE IS AS FOLLOWS OSSMANN RAFFLE BEGAN IN THIS FISCAL YEAR THE RAFFLE PAYOUT OF 11500 WAS MADE IN FISCAL YEAR ENDED 06302012
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


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