Attach to Form 990 or Form 990-EZ.
See separate instructions.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization in col. (i) listed in your governing document? | (v) Did you notify the organization in col. (i) of your support? | (vi) Is the organization in col. (i) organized in the U.S.? | (vii) Amount of monetary support | |||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | 0 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.).. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 13,288 | 13,288 | ||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | 13,288 | 13,288 | ||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | 13,288 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 13,288 | 13,288 | ||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 13,288 | 13,288 | ||||




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Software ID: | 13000230 |
| Software Version: | 13.6.0.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990-EZ, Part I, Line 8, Other Revenue | Rental income 4,809 |
| Form 990-EZ, Part I, Line 8, Other Revenue | Lotto 519 |
| Form 990-EZ, Part I, Line 8, Other Revenue | Miscellaneous 526 |
| Form 990-EZ, Part I, Line 8, Other Revenue | Advertising 180 |
| Form 990-EZ, Part I, Line 8, Other Revenue | Fundraising 5,343 |
| Form 990-EZ, Part I, Line 8, Other Revenue | Purple ball 3,296 |
| Form 990-EZ, Part I, Line 8, Other Revenue | Golf tournament 476 |
| Form 990-EZ, Part I, Line 8, Other Revenue | Hospitality room 2,250 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Depreciation 17,693 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Insurance 4,477 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Janitorial 5,646 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Office supplies 3,759 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Officers expense 2,830 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Grand lodge dues 5,679 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Repairs and maintenance 13,610 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Genral business taxes 1,631 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Security 405 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Public relations 6,076 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Public contributions 18,920 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Youth services 5,165 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Miscellaneous 127 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Cash shortage 297 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Hospitality room 2,116 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Purple ball 2,200 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Contract labor 659 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Supplies 3,099 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Veteran services 1,725 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Payroll taxes 6,346 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Entertainment 69 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Golf tournament 160 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Kitchen supplies 414 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Convention expense 2,887 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Fundraisers 200 |
| Form 990-EZ, Part II, Line 24, Other Assets | Inventories Beginning of year 3,321, End of year 3,597 |
| Form 990-EZ, Part II, Line 24, Other Assets | Deposits Beginning of year 100, End of year 100 |
| Form 990-EZ, Part II, Line 26, Liabilities | Accounts payables Beginning of year 2,118, End of year 2,170 |
| Form 990-EZ, Part II, Line 26, Liabilities | Prepaid dues Beginning of year 13,435, End of year 17,284 |
| Form 990-EZ, Part II, Line 26, Liabilities | Restricted funds Beginning of year 10,000, End of year 10,000 |
| Software ID: | 13000230 |
| Software Version: | 13.6.0.0 |
| Person Name | Explanation |
|---|