2001
Under section 8!Q7(e), 527, or 4947(aX1) of the Internal Revenue Code (except black long
benefit trust or private foundation)
Qepsrtment of the Treasury
tnte~rred Revenue service
Name change
The organization may have to use a copy of this return to satisfy state reporting
0 5 - 01 . 2x01 . and endirn
Please C Name a# organbAtion
LOYAL ORDER OF MOOSE 576 ~'-'N~
Primer
Number and street (of P.O. box if nom Is not delivated to street address} aoor,r
Final return
specift
A Fog the 2001 calendar year, or tax year beginning
8 Check If applicable:
Q aaaresscnange
Amended return
Applicatib. pending
a,
OMB No. 1sas-oae7
'Retehn of organization Exempt From Income Tax
F`
2400 NORTH sTxTE xwY 3
City or town, state or country, arid ZIP + 4
NORTH VERNON,
IN 47265
Q other t1 b-
~ Soc~an':0"
and
('Q ~xma~ept
mssmiscatt~acompte~easd~eaulsa(Fa~a9sorir`~ilo-ExJ .
j OroRlYPe(eheGcoNyr-)
04-30,2002
D EmpbyerldenWiraHan 1neder
35-4312169
ETeiephonenanber
PI' Qg 501(e)( ~( ) A(insertrp.)
U 491T(aj('1) a
x cnacc nece 0- Off the cayarazatka'es growreceipts am normally riot mom thw$M.000. The
527
tioet rimed not Sea reiuriewil hthe IRS; but if the organization received a Farm 994 Package
inthemail.Rshouldfik+areUxnurithaitfinanefaldaia.5amietequUasaeomPletenhrn
Ha~C we not appOeable to section 527 organisations.
LV-% I- *%,.t- agta req- taasfl~ates?
W
JO.
HM ff -Yes,' enter number of affiliates
D Y- MU-
E" ,re ag af tes
filia
Included?.
(f-No,-attach a fit. See
ova
nu6n9?
H" :=====
f
Entix4-dMRGEN 1- 0002
nym O NO
~ 1Resc Q !b
M Check t 0 if the organ¢ation is riot required
L GroSS receipts. Add lines sb, Sb, sb, and 1ob co One 32 >
to attach Sch. B (Form 590, 990-E2. or 990-PF).
Expenses,
and
C
in
Net
Assets
or
Fund
Balances
(See specific Instructions on eye 1s.)
. . . Revenue,
... . . . i Contributions, gifts, grarNs, and similar amounts received:
-"...
a Direct public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is
6 , 272
b Indirect pubic support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
C GOYB1'IIIYIe1'it contributions (grants) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
IC
d Tots! (add fines 1a through 1t) (cash $
toneash $
~ . . . . . . . . . . . . . . 1d
6,272
6,272
2
2 Program service revernte incki*g govefRxrant fees and contracts (from Part VII, line 93) . . . . . . . . . . . . . .
3
3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
'870
4 Interest on savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
329
. .
. . . . . . . . .
S
5 Dividends and interest from securities . . . . . . . . . . . . . . . . . . . . . . . . . .
fia Gross reins . . . . - - - - . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . .
6a
b Less: rental expenses . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . .
6b
x ..kSr»~
C Net f+2r" income OF (loss) (subtract
6F! from fine Ea) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vj GCh
s 7 Other investment incorrie (describe 10,
v
(A) Securities
{B} Other
8a Grass amount from safes of assets other
s
than inventory . . . , . . , > . . . . . . . . . . . . . . . . . . .
8a
. . . . . . . . . . .
R
b less: cost or her basis and sales expenses
$b
'; ..
e
SC
C Gain or (loss) (attach schedule) . . . . . . . . . . . . . . . . , * .
tL Not CJ'dtl'E O( (Io!S3) (combine it* SC> COli!'1'k'tS (A) and (B)) . . . . .. .. . . . . . . . . . f . . .. . . . . . . . . . . .
S(J
9 Special events and activities (attach schedule)
a Gross revenue suit '
$
of
co'tri1xidol'IS reported OFI 1im Pdj . . e . . . . s . . . . . . . . . . w . . . . . e . . . .
a"
b Less: direct expenses other than fundraising expenses
. . . . . . . . . . . . . . . .
9b
c Not income or (loss) from special events (subtract line 9b from line 9a) . . . . . . . . . .
10a cps o¬ inventory, less returns and allowances
. . . . . . . . . . . . . . . . .
. 1oa
109 , 063
b less: cast of goods sold , . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .
lob
5 3 3 5 5'
c Cuss profit or (loss) from sales of inventory (attach schedule) (subtract fine itNb from line t0a) " - - . . . . . . . .
55,708
tt Other revenue (from Pact V11* one i03) . . . . . w . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
t1
12 Total revenue tea lines Id, 2, 3, a> s, sc, 7, ft 9c, 1oc, and 11)
12
68 379
p 14 Management and general (from lina 44, column (C)) . . . . . . . . . . . .
is wnar(frorn line aa, column (o)) . . . . . . . . . . . . . . . . . . .
16 Payments to affiliates (attach schedule) . . . . . .
a
. . . . . . . . . . . .
s 17 Total expenses (act! lines 16 and 44, column (A))
'C8 Excess or (deficit) for the mar (subtract line 17 fin line 12)
.
" Not assets air fund balances at bed of year (**In line 73, column (A))
s 20 Other changes K
in not assets or fund balances (attach explanation) . . . .
1-21 Not assets or fund balms ac end of year (combine yes 1s, is* and
'or Paperwork Reduction Art Notice, see the separate ructions.
/~
1L!
.
. . . . .lRS . 0'5C .
. . . . . .
. . . . . .
. . . . . MAY
. . . . . .
. .
. . . .
. . . . . . . . . . . . . . . . . . . .
. .
' EEn "
14
Is
t6
1?
Is
Z~
2't
- /
94,072
1
C QA~
,,
~
120,071
94,178
Form 990 f2001)
F~
~v (zw' )
S
Page 2
nlerr! of
Functional Expenses
Do not include amours reported on fine
6b, 8b, 9b, 10b, or 16 of Part I.
Grants and allocations
ns. (attach schedule}
(cash $
6 , 9 6 3 noncash $
Specific assistance to individuals (attach schedule)
Benefits paid to or for members (attach schedule) .
Compensation of officers, directors, etc. . . . . . .
Other salaries and wages . . . . . . . . . . . . .
Pension plan contributions . . . . , - - , " - - Other employee benefits . . . . . . . . . . . . .
Payroll taxes . . . . . . . . . . . . . . . . . . .
Professional fundraising, fees . . . . . . . . . . .
Accounting fees . . . . . . . . . . . . . . . . .
Legs! fees . . . . . . . . . . . . . . . . . . . .
Supplies . . . . . . . . . . . . . . . . . . . . .
Telephone . . . . . . . . . . . . . . . . . . . .
Postage and shipping . . . . . . . . . . . . . . .
Occupancy . . . . . . . . . . . . . . . . . . .
Equipment rental and maintenance . . . . . . . .
Prireing and publications . . . . . . . . . . . . .
Travel . . . . . . . . . . . . . . . . . . . . . .
Conferences, conventions, and meetings . . . . .
Interest . . . . . . . . . . . . . . . . . . . . . .
Depreciation, depletion, etc. (attach schedule) . . .
22
23
24
25
26
Z7
29
29
30
31
32
33
&1
35
36
37
38
39
40
41
42
43
All orgadretona must rnnplete caunn (Al. cohsne (e). (c.7. WKI (D) are required for section 501(co) and (4) organizations
and section 4s+7(a(1) nomocempt charitable wets but optional for arms. (see Specific: Instructions on page z t.)
19
)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
a ADVERT
MISC OTHER TAXES
other expenses not covered above ptemizek
b SALES TAX,
e PRIZES
d MISC
e STATE AN NATIONAL DUES
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
,v
~~ ~
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
'J9
40
41
42
43a
43b
43e
Ai3d
43e
TAI fwifonal aqaoes (add lines 22 through 43) . Or~a
44
(B) Program
services
(A) Total
(C)
Management
and general
(D) Fundraising
6 , 963
228
19,175
9 1 246
775
10 , 902
859
1 , 023
15 , 017
3 , 440
1,657
1,569
8,736
343
5469
100
876
7,694
complelling column"). a+ynuese mrab to Ems i3-is .
. ~ 44
94,072
Joint Comes. Check 10- [] it you are following SOP 98-2.
Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? . . . . . . ~
If Yes," enter (i) the aggregate amount of these joint costs $
: (ii} the amount allocated to Program services $
E]Yes IM Ib
(ill) the amount allocated to Management and general E
; and (iv} the amount allocated to Fundraising $
___ Statement of Program Service Accomplishments (see Specific tr,struceor,s or, Page 24 .)
What is the organization's primary exempt purpose? b- FRATERNALISM
AK organizations must describe their exempt purpose achievements in a clam and concise manner. State the number
of clients served, publications issued, etc. Discuss achievements that are not measurable. (Section 50i(cx3) and (4)
ort,~arwzations and 4947(aXt ) nonexempt charitable trusts must also enter the amount of grams and allocations to others.)
a
THE LODGE UNITES ITS MEMBERS IN THE BONDS OF FR.ATERN
BENEVOLENCE AND CHARITY
.)
for others
(Grants and allocations S
b
(Grants and allocations $
c
(Grants and afbcations S
d
e UaM p~
f Total of
qufroa for so1(c)(3) and
ergs, and 4947(aX1)
; but optional
trusts
services laRach scneawe)
(Grants and allocations $
(GrarMs and avocations $
equal ins 44, column (8), Program services)
EEA
990 (2001
.M(SM11
f-
Page 3
$a~ Sheets
~c
(See Specific Instruc6ons on page 24 .)
Note.~ Where required, attached schedules and amours within the description
column show be for end-of-year amounts only.
4'3
Cash - non-interest-bearing . . . . . . . . . . . . . . . . . . . . . . . . .
46
B
Savings and temporary cash investments . . . . . . . . . . . . . . . . . . .
47 a Accounts receivable . . . . . . . . . . . . . . .
b Less : allowance for doubtful accounts . . . . . .
'
(A)
of yeas
13 , 547
15,000
47a
4m
(B)
End of year
8 , 819
45
46
k ~:
'`
47c
15 , 609
"
JMM
~
4S a
b
49
50
A
s
s
Pledges receivable . . . . . . . . . . . . . . . .
'~4$a
~x>:ox:."
Less : allowance for doubtful accounts . . . . . .
48b
4"c..
Grants receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
Receivables from officers, directors, trustees, and key employees
50
(attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51 a Other notes and bans receivable (attach ;,
schedule . . . . . . . . . . . . . . . . . . . . .
51a
<~~N~>
b Less: allowance for doubtful accounts . . . . . .
51b
. 51c
5. . . . .n
e
t
s
52
Inventories for sale or use
. . . . . . . . . . . . . . . . . . . . . . . . . .
53
Prepaid expenses and deferred charges - - . . . . . . . . . . . . . . . . .
SA
Investments - securities (attach schedule) . . . . . . . " E] Cost [] FMV
55 a Investments - land, buildings, and
~~~
~~
~~~~70
~7
equipment: L70
5~ .
. .
.
.
. .
.
. . .
.
. .
.
.
~
b Less : accumulated depreciation (attach
schedule) . . . . . . . . . . . . . . .
Si
Investments - other (attach schedule) .
57a Land, buildi
basis
, and
b Less : accumulated depreciation (attach
schedule) . . . . . . . . . . . . . . .
ngs
`
a
6
y
e
. . . . . .
. . . . . . .
. . . . . .
55b
. .
57a
. . . . . .
S7b
. . . . . . . . .
236,270
5 , 500
59
Total assess (add fines 45 through 58) (must equal line 74) . . - - - . - - . -
Accounts payable and accrued expenses . . . . . . . . . . . . .
Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . .
Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . .
Loans from officers, directors, trustees, and key employees (attach
schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
64a Tax-exempt bond liabilities (attach schedule) . . . . . . . . . . .
.,55c:
56
277,079
:yC;sI;G!y;
Other assets (describe
60
61
62
63
53
54
.~'tf
.,:'
rr
58
DEPOSIT
52
4,417
)
250
. . . . . .
. . . . . .
. . . . . .
. . . . . .
. . . . . .
b Mortgages and other notes payable (attach schedule) . . . . . . . . . . . . .
66
Other liabilities (descnbe PMISC UTILITIES ETC
)
s
. .57c~
250
59
307,257
269,484
58
60
61
62
:v
149,413
64a
64b
65
66
Trial amides (add fees 60 through 65) .
66
149,413
Onganizadons that follow SFAS 117, cheek here t
u and complete lines
67 through 69 and lines 73 and 74 .
67
Unrestricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
N F
68
Temporary restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
68
e u
t n
69
Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . .
69
:~::<;rF
A
Organizations that do not foRaw SFAS 117, check here b~ and
s B
complete lines 70 through 74.
;~~'
s a
TO
Capital
stack,
truest
principal,
or
cumerk
funds
.
.
.
.
.
.
.
.
.
705
.
.
.
.
.
.
.
.
e I
t a
71
Paid-in or capital surpkis, w land, building, and equipment fund . . . . . . .
71
s n
72
Retained eamings, endownwnt, accumulated incone, a other funds . . . . .
120,071
72
e
73
TaW net assets of fund balances (add fines 67 through 69 OR ones
:
o e
r 5
70 through 72;
. .~.
column (A) must equal One 19; column (B) must equal lire 21) . . . . . . . .
120,071
73
74
Total IiWbiNes and net assets / land balances (add lines 66 and 73) . . . . .
~
269,484
74
Form 990 is available for public inspection and, for some people, serves as die primary or sole source of information about a
particular organization. How the public perceives an organization in such cases may be determined by the information presented
on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's
programs and accomplishments.
EEA
18 , 553
152 , 077
1,015
171,645
171,645
t
HeconcillaNOn of Revenue per Audited
Financial Statements with Revenue peir
Return (see specific instructions, page 2s.)
Total revenue, galas, and other support
per audited financial statements
b
Amounts included on fine a but not on
line 12, Form 990:
(1)Net unrealized gates
on investrrleMS . . :
(2) Donated services
and use of facilities
(3) Recoveries of prior
year grants . . . . $
(4) Other (specify) :
a
68,17
~.. ,.. .:..~;:, .. .
a
b
(1)
(2)
(3)
(4)
i
Add amours on fines (1) through (4)
e
d
(2) Other (specify):
e
TAI revenue per fine 12. Form 990
e
.
t
68,179
^'~`<~"~< :
::?e
...
.
Total expenses and losses per
audited financial statements . . . . .
Amours included on line a but not
on line 17, Form 990 :
Donated services
and use of facilities
Prior year adjustments
reported on firm 20,
Form 990 . . . . . .
Losses reported on
line 20, Form 99o
Other (specify):
4
' .94 . 0'7
.> wYr:- ~ ~ . : ;
Y"Win. S
L
~k. .. . .
S
Line a minus line b
. . . . . . . . . ~
Amounts included on fine 12,
Form 990 but not on line a:
(1) Investment expenses
not included on line
6b, Form 990 . . . . S
Add amounts on lines (1) and (2) .
Reconciliation of Expenses per Audited
Financial Statements with Expenses per
Return
c
d
De
Add amounts on ones (1) through (4)
Line a minus fine b
94,072
. . . . . . . . .
An-curds included on line 17,
form 990 but not on line a:
-'. < = 3 '`~
(1) Invesbrient expenses
?<:" :s:~f .:
riot ceded on line
bb, Form 990 . . . . ~
~i5~^S.
~:~<<,yf
:~l
(2) Other (specify):
,: ~:r. ...,::~>.c.~: . .......:.. ..... :. .: .:.. . ...::.
........ .
d
a
Add amounts on dace (1) and (2) .
. .
.. . .. ~.~........ ......:,.
. . . ..,.,-,.
. .. . . ..........,.... .. :. ... ...:.:
..
d
~
Tots! expenses per fine 17, Form 990
(fine c plus line d) .
t e
68, 179
(line e plus fine d) .
~ e
94,072
List O} Officers, Directors, Trustees, and Key Employees (List each one even if not compensated; see Specific
JMW
75
Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your
cuganaation and all related organizations, of which more man $10,000 ryas provided by the related orgartimations?
If "Yes," attach schedule - see Specific Instructions on page 27 .
EEA
11,
n Yes ~X No
Form 990 (2001)
Fam 990 (2001 )
., . , dthW 1CffOTtttt (See Specific Instructions on pa
2? .)
repoated to the !!tS? # "YWattach a
of each equity . . . .
76 `.V Did the OPnWMM eegage In air actl+ritY not
77
Were ally changes made in the organizing or governing documents but not reported to the IRS? . . . . . . . . . .
!f "Yes," attach a conformed copy of the changes.
711a Did the organization have t 'eiated business cross income of $1,000 or mots during the year covered by ttds return?
b If "Yes ." has it fwd a tax return on Form 99E1-T for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
79
Was there a liquidation
; dissolution. terrnitnation. or substantial contraction during die year? If "Yes," attach a statement
80a, Is the organization related (offset than by association with a statewide or nationwide organization) through common
. . . .
mew, governing bodies, trustees, officers, etc., to any other exempt w nonexempt organization? .
b it "`lei," enter the name of the organization
exerr~st OR
more~cempt
and check whether it is
.
.
76
7?
.
.
.
78d
78b
79-
.
,~. .
8~~
``c" .,
~ :
81a Enter direct or indirect political expenditures. See line 81 Instructions . . . . , . . . . .
8ta
b Did the organization file Form 1124-POL for this year? . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .
82a Did the organization receive donated services or the use of material, eciuiPmeM or facilities at no charge
of at substantially less than fag rental value? . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . .
b
83a
b
84a
b
$'S
b
a
d
e
f
g
h
86
if "Yes," You may indicate the value of these items here. Do not hwlude this amount
as revenue in Part 1 w as an expense in Part q, (See suctions in Part Ifl .) . . . . . . . .
Did the organization comply with the public inspection requirements for returns and exemption appGcations? . . . .
. . . . . . . .
04 the organization comply with the disclosure requiremerxs relating to quid pro qua contributions?
Did the organization solicit any ins or gets dot were rat tax deductible? - - . . . . . . . . . . . . . . . .
V'Yes," did the organization include with every solicitation an egress statement that such cordons
or gifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
501(cX4), (5), or (6) organizations. a Were substantially all dues nondeductible by members? . . . . . . . . . . . .
Did the organization make only in-house lobbying expenditures of $2 .000 of less? . . . . . . . . . . . . . . . . . .
If "Yes" was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization
received a waiver fog proxy tax owed for to prior year.
cues, assessrnerds, and similar amounts from members . . . . . . . . - - - . . . . .
a5c
Section 162(e\f lobbying
_!°~' and /~~
political expenditures
. . . . . . . . . . . . . . . . . . . . . 85d
'Y~
85e
Aggregate nondeductible amount of section 6033(eX1XA) dues notices . . . . . . . . .
Taxable amount of lobbying and political ewes (ir+e 85d less &5e) . . . . . . . .
esf
Does the organization elect to pay the section 6033(e) tax ors ft amotrt on line 8sf? . . . . . . . . . . . . . . . .
1f section 6033(eX1 XA) dues notices were serf, does the organization agree to add the amount on line 85f to its
reasonable estimate of dues allocable m nondeductible lobbying and political expenditures for the following tax year?
5Q1(cx7) orgs. Eriter. a Initiation fees and capital contributions girded on fine 12 . . .
863
Gross receipts, included on line 12, for public use of club facts . . . . . . . . . . . .
86b
.
.
.
.
.
.
.
.
.
.
07
501(cX12) orgs. Enter: a Gross kvAxm from members or shareholders
87a
b Gross income from other sources . (Do not rat amounts due or paid to other
sources against amounts due or received from them.) . . . . . . . . . . . . . . . . . . . an
88
At any lime during the year, did the organization own a 50°h or greater interest in a taxable corporation or
partnership, or an entity disregarded as separate horn the organization under Regulations sections
3Q1 .7701-2 and 301 .7701-3? If "Yes," complete Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . .
89a SD1(c}j3) organiz:atlons. Enter- Amount of tax imposed on the organization during the year under:
section 4911 1
; section 4912 r
; section 4955
b 501(cX3) and 5Uf(eX4) orgs . Did the organ engage in arty section 4958 excess berg transaction
dung !he year or did it become aware of an excess benefit transaction from a prior year? If "Yes," attach
a statement eking each transaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a Enter. Amount of tax imposed on the organization managers or disqualified persons during the year under
sections 4912, 4955, and 4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . .
d Enter: Amount of tax on line 89c, above, reimbursed by the organization . . . . . . . . . . . . . . . . . . .
90a List the states with which a copy of this return is filed lob Number of employees employed in the pay period that includes March 12, 2001 (See instructions) . . . . . .
91
The books are in care of >
Telephone no . b Located at 092
Section 4947(aXt) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here . . . . . .
and enter the amount of tax-exempt interest received or accrued during the tax year .
~
eEa
.
.
.
.
.
.
Yes
X
x,
,X
- - -- -
81b
X
oft
X
83a
X
X
X
83b
84a
Page 5
too
=y
84b
85a
85b
"`~~ .t c `'
:rile
.
.
y :`
. . . .:s
85h ~~.
b
. . . . .
88
. . . . .
89s
. . .
. . .
.
X
t
90b
. .
. . . . . . .
~ 92 '
Form 990 (2001)
Form 990
8
NoW Eitt
Enter gross aiRtS unless otherwise
93
mar.
Program service revenue:
a
b
c
d
e
(A}
1
(8)
r
Faces by so
2,513,514
EkchWon code
Amatrd
(c)
(E)
WOr
ruricnon
MEMBERSHIP ACTIVITIES
Medicare/Medicaid payments . . . . . . . . . . . .
Fees and contracts from government agencies . .
Membership dues and assessments . . . . . . .
Interest on savings and temporary cash investments
Dividends and interest from securities . . . . . . .
97
Net rental Income or (loss) from feat estate :
102
103
ilrried business Mme
6ushmmaode
f
g
94
9'S
96
98
99
100
101
fIf1ES (See Specific tnsVuctiotts on page 32.
a
b
14
debt-financed prop . - . . . . . . . . . . . .
not debt-financed property . . . . . . . . . . .
Not rental income or ( loss) from personal property .
Other investment irmrrae . . . . . . . . . . . . . .
Gain or (low) from yes of assets other than inventory
Diet income or (bss) from special events . . . . .
Gross profit or (loss) from sales of inventory . . .
Other revenue : a
b
c
d
e
18
104
Subtotal (add columns (BI (DI end (E)) " - - " "
105
Total (add line 104, columns (B), (D), and (E)) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Notes : Line 105 plus line 1d, Part I, should equal the amount on line 12, Part I.
..qu
. Line Na
. Relatianshi
of Activities to the Accom fishmerd of Exempt Pur
a (see specific
n~ instructions on pa
Explain how each activihr for which income s reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt purposes (other than by providing fins for such purposes).
instructions on paw 33.
Nam, address, ahdEIN of corporation,
I
Nature
Total
o
_ ..,..M Information Regarding Transfers Associated with Personal Benefit Contracts (See Specific Instructions on paces: 33.)
(a)
(b)
ntd the wgantzatior, aurin9 the yam. reeeave any fuel, dreety or hwkee+Ur, wpay pona personal eeriettc c«waet?
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
Note: If "Yes" to (b), fife Form 8870 and Farm 4720 (see instructions).
Under PeraMes af PeI". t declare that I trove mcxnhied this rehxn,
and beflegAtN true, correct, and ate. Deginatim of pseparer (other
P$'
Hkam
` Type
Preperor'S
sFir's terms (orYa~xs
aixs
mss,
t ZtP ~ 4
~~ ACCOUNT'
~,
215 HOOSIER STR;
I
NORTH VERNON IN
. . . . . .
El Yes
[' Na
. . . . . .
[]Yes
[]No
SCHqPLk-k A
(F~miiO or SWEZ)
Deparbnowt of the T-asury
howwReverumserwke
Organization Exempt Under Section 501(cX3)
(E,,=(nX
P*:1se=
aW wid Seedw 501(o), S01(tj 501(k),
aXI) NonexwW Charitable Thist
OMB No. IS4S-0047
2001
SuppWnentary Info"nation -- (See separate knbuctions.)
MUST be completed by the above organ
and aftadwd to Vveir Form 990 or 990-EZ
ORDER OF MOOSE 576
Cwnpensallon of the Five H4hest Paid Employees Odw Than OWN
(See page 1 of the instructions . List each one. If there are none, enter "None.")
00 Hame and address of each ewp" paid more
(b) Me arw averege hours
C-rip-tion
tharl$501000
I per vweek devoted to position
Total number of other employees paid over
$-%ODD . . . . . . . . . . . . . . . . . . .
lo-
(See page 2 of the Instnictions. List each one (whether individuals or
35-0312169
(b) F.~
to I
MS& accouritandother
tractors for Professkmal
It tore are none, enter *Nor*.*)
(a) Name and address of each kideperiderd contractor pald awre than $50,000
ft Type of servke
(c) Compensad-
None
TOW number of others recervrQ over $5DOOD for
professional serAces . . . . . . . . . . . . .
*
I
F-Papermck PleductImAct Notk :esee the kwtrw~for ftrrnmoor Foi
M
EEA
ScheduIeA(ForM990or990-EZ)2W1
Form
Overflow Statement
%7*7V
Name as shown on Return
Employer identification number
LOYAL ORDER OF MOOSE 576
35-0312169
------ OCCUPANCY -------Form 990
Description
INSURANCE
UTILITIES
Total
2001
Amount
7,435
7,582
15,017
------ overflow for : ------Form 990
Description
Amount
SALES TAXES
3,389
PROPERTY TAXES
1,500
LICENSES AN PER
580
Total
5,469
--MISC EXP LINE 43 D--Form 990
Description
Amount
PRIZES
100
LAUNDRY
697
FLOWERS
79
Total
876