Form 990 - Return Of Organization Exempt From Income Tax - 2013 Page 29

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ScheduleG(Form 990 or990-EZ)2013
Page3
11
Does the organization operate gaming actiVities With nonmembers?
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I Yes I No
12
Is the organization a grantor, benefICIary or trustee ofa trust or a member ofa partnership or other entity
formed to administer charitable gaming?
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I Yes I No
13
Indicate the percentage ofgaming actiVity operated in
The organization's faCIlity
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13a
%
An outSIde faCIlity
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13b
%
14
Enterthe name and address of the person who prepares the organization's gaming/speCIal events books and records
NameI'
Address I"
15a
Does the organization have a contract With a third party from whom the organization receives gaming
revenue?
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I_Yes|_N
b
If "Yes," enter the amount ofgaming revenue received by the organization It $
and the
amount ofgaming revenue retained by the third party It $
C
If"Yes," enter name and address ofthe third party
Name?
Address It
16
Gaming managerinformation
NameF
Gaming manager compensationP$ ___________________________________________ __
Description ofserVIces prOVIded It _________________________________________________________________________________________________________________________________________________ __
' Director/officer
' Employee
' Independent contractor
17
Mandatory distributions
a
Is the organization reqUIred understate lawto make charitable distributions from the gaming proceeds to
retainthestategaminglicense?
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|_Yes
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b
Enterthe amount ofdistributions reqUIred under state law distributed to other exempt organizations or spent
in the organization's own exempt actiVities during the tax year? $
Part IV
Supplemental Information. Prowde the explanations reqUIred by Part I, line 2b, columns (iii) and (v), and
Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to prowde any
additional information (see instructions).
Return Reference
Explanation
Schedule G (Form 990 or 990-EZ) 2013

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