Form 990-Ez - Return Of Organization Exempt From Income Tax - 2012 Page 11
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15Schedule G (Form 990 or 990-EZ) 2012
Page 2
Fundraising Events . Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported
more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List
events with gross receipts greater than $5,000.
(a) Event #1
(b) Event #2
(c) Other events
(d) Total events
(add col (a) through
12 HONOR BAN
col (c))
(event type)
(event type)
(total number)
co
1
Gross receipts
27,860
27,860
75
2
Less Contributions
3
Gross income (line 1
minus line 2)
27,860
27,860
4
Cash prizes
u7
5
Noncash prizes
6
Rent/facility costs
7
Food and beverages
8
Entertainment
9
Other direct expenses
19,382
19,382
10
Direct expense summary Add lines 4 through 9 in column (d)
.
(19,382)
11
Net income summary Combine l i n e 3 , column (d), and l i n e 10
478
8 , 4 7 8
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.
(a) Bingo
(b) Pull tabs/Instant
(c) Other gaming
(d) Total gaming (add
bingo/progressive bingo
col (a) through col
co
(c) )
1
Gross revenue
.
2
Cash prizes
u)
C
3
Non-cash prizes
LIJ
4
Rent /facility costs
.
5
Other direct expenses
F Yes
F Yes
F Yes
6
Volunteer labor
n No
F No
F No
7
Direct expense summary Add lines 2 through 5 in column (d) .
.
.
.
.
.
.
.
.
.
.
8
Net gaming income summary Combine lines 1 and 7 in column (d) .
9
Enter the state(s) in which the organization operates gaming activities
a
Is the organization licensed to operate gaming activities in each of these states?
.
.
.
.
.
.
.
.
.
.
.
.
. Yes r No
b
If "No," explain
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10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year?
.
.
.
.
.
F
Yes F
No
b
If "Yes," explain
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Schedule G (Form 990 or 990-EZ) 2012
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