Woodmen of the world - Assured Life association

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Camp/Lodge Annual Report 2011

Deadline is March 31, 2012 

Note:  Please answer each question unless directed otherwise. 

  1. Camp/Lodge No.:
  2. City of Camp/Lodge:
  3. State of Camp/Lodge:
  4. Name of Individual & Position completing the form:
    5. CAMP/LODGE FINANCIAL PROFILE FOR IRS REPORTING
  5. Legal Name of Camp/Lodge (name used for bank account):
  6. Annual Tax Period (calendar or other fiscal period):

  7. If Other Fiscal Period is selected enter fiscal ending date: Date Format: MM/DD/YYYY
  8. Are camp/lodge annual gross receipts normally $50,000 or less?

  9. Other names used by Camp/Lodge (if not applicable, type "None"):
  10. 1. Total amount of camp/lodge gross income for 2011 from all sources including any money raised through fundraising, member donations, dues, interest income, etc.:
    11. Items a-c reported below should equal total amount of gross from all sources reported above.
  11. a. How much of income was generated by local camp/lodge dues? If none enter $0
  12. b. How much of income was generated through fund-raising activities? If none enter $0
  13. c. How much of income was generated through all other sources? If none enter $0
  14. 2. Total amount your camp/lodge donated to non-profit organizations or underserved individuals during 2011 (this amount should include the cost of organizing fundraising events and activities, cash donations, etc.): If none enter $0
  15. List the non-profit oganizations/individuals that your camp/lodge assisted in 2011 (if none, report none):
  16. 3. Total dollars spent to maintain and operate the camp/lodge in 2011 (this amount should include meeting space rental, postage, printing, utilities, insurance, supplies, advertising, refreshments, etc.):
  17. Does your camp/lodge own its own building?

  18. 4. Did your camp/lodge grant or provide college scholarships in 2011? If No, go to OFFICIAL LOCATION OF CAMP/LODGE RECORDS Section.

  19. If so, how many scholarships did you grant?
  20. If so, what was the total amount of scholarships provided?
    21. OFFICIAL LOCATION OF CAMP/LODGE RECORDS (Normally camp/lodge secretary address or camp/lodge building address, if applicable)
  21. Officer Name:
  22. Officer's Position:
  23. Street Address:
  24. City, State and Zip:
  25. Does your camp/lodge have social (non-benefit or insurance) members?

  26. If so, how many social members are in your camp/lodge?
    27. FRATERNAL BUSINESS & SOCIAL ACTIVITIES OR EVENTS:
  27. 1. Does your camp/lodge have regularly scheduled business meetings? If No, enter 0 for each question in this section.

  28. If so, how many business meetings did you have during 2011? If no business mtgs, enter 0.
  29. What was the average attendance per business meeting? If no business mtgs, enter 0.
  30. What was the average length of your business meetings (to the nearest whole hour)? If no business mtgs, enter 0.
  31. 2. Did your camp/lodge sponsor social events or camp/lodge fellowship gatherings for members and guests during 2011? If No, enter 0 for each question in this section.

  32. If so, how many member/guest social events did you have during 2011? If no social events, enter 0.
  33. What was the average attendance per social event? If no social events, enter 0.
  34. What was the average length of your social events (to the nearest whole hour)? If no social events, enter 0.
  35. 3. Did any of your 2011 social activities involve fundraising for your camp/lodge operations or scholarship program? If No, skip to question #4 in this section.

  36. If so, report the number of fundraisers for camp/lodge operations in 2011?
  37. If so, reoport the number of fundraisers for camp/lodge scholarship program:
  38. 4. Did any of your 2011 social activities involve youth (e.g. Christmas Party, Picnics, etc. - do not report Join Hands Day Projects here)? If No, go to COMMUNITY SERVICE ACTIVITIES OR EVENTS Section.

  39. If so, how many activities included youth?
  40. If so, what was the average attendance of youth per activity?
  41. Short description of events including youth:
    42. COMMUNITY SERVICE ACTIVITIES OR EVENTS:
    (Event or Activity must be a camp/lodge sponsored event involving two or more members - includes camp/lodge participation in Society sponsored programs like the National Member Food Drive, Join Hands Day and Operation Santa's Elves)
  42. 1. Did your camp/lodge do a Join Hands Day project in 2011? If No, skip to question #2 in this section.

  43. If so, how many total members/non-members, including youth, helped with the project?
  44. Describe your Join Hands Day project:
  45. How many were youth?
  46. How many volunteer hours were spent on the project (total of all members' and non-members' volunteer time including organizing)?
  47. 2. Did your camp/lodge support any local educational programs or projects in 2011 (e.g., adopt-a-school program, school supply drives, etc.)? If No, skip to question #3 in this section.

  48. If so, describe the program or project:
  49. How many educational programs or projects did you support?
  50. How many schools were served by the project?
  51. How many students were served by the project?
  52. How many members partcipated?
  53. How many non-members participated?
  54. How many volunteer hours were spent (total of all members' volunteer time including organizing)?
  55. Camp/Lodge funds spent in support of the project:
  56. Camp/Lodge funds donated to the school:
  57. 3. did your camp/lodge support a patriotic-related project in 2011? If No, skip to question #4 in this section.

  58. If so, describe the program or project:
  59. How many patriotic-related programs or projects did you support?
  60. How many members participated?
  61. How many non-members participated?
  62. How many volunteer hours were spent (total of all members' volunteer time including organizing)?
  63. Camp/Lodge funds spent in support of the project:
  64. Camp/Lodge funds donated to patriotic groups:
  65. 4. Did your camp/lodge support a service project for the elderly in 2011? If No, skip to question #5 in this section.

  66. If so, describe the programs or projects:
  67. How many projects or programs for the elderly did you support?
  68. How many members participated?
  69. How many non-members participated?
  70. How many volunteer hours were spent on the project for the elderly(total of all members' volunteer time including organizing)?
  71. Camp/Lodge funds spent in support of the project for the elderly:
  72. Camp/Lodge funds donated to groups in support of the elderly:
  73. 5. Did your camp/lodge support an ethnic or cultural activity in 2011? If No, skip to question #6 in this section.

  74. If so, describe the programs or projects:
  75. How many ethnic or cultural activities did you support?
  76. How many members participated?
  77. How many non-members participated?
  78. How many volunteer hours were spent on the ethnic/cultural activity (total of all members' volunteer time including organizing)?
  79. Camp/Lodge funds spent in support of ethnic/cultural activity:
  80. Camp/Lodge funds donated to ethnic/cultural groups:
  81. 6. Did your camp/lodge participate in the Society's National Member Food Drive in 2011 (please report here even if you submitted a report of your activity on a national member food drive reporting form)? If No, skip to question #7 in this section.

  82. If so, how many pounds of food were collected?
  83. Approximate $ value of the food collected :
  84. Approximate $ value of clothing or other items collected:
  85. Amount of money donated to local food bank/pantry or food program:
  86. How many volunteer hours were spent (total of all members' volunteer time including organizing)?
  87. Description of food drive event or program:
  88. 7. Did your camp/lodge participate in the Society's Operation Santa's Elves in 2011 (please report here even if you submitted a report of your activity on an Operation Santa's Elves reporting form)? If No, skip to question #8 in this section.

  89. If so, how many gifts were collected for children?
  90. Approximate value of all gifts collected:
  91. How many children were impacted by your project?
  92. What other items or food were collected through your project?
  93. Approximate value of the other items collected?
  94. Amount of money donated to local toy or holiday program:
  95. How many volunteer hours were spent (total of all members' volunteer time including organizing)?
  96. Description of Operation Santa's Elves event or project:
  97. 8. Other than monetary donations, did your camp/lodge do any other community service, fundraising for other non-profit organizations or volunteer activities in 2011 not already reported in questions 2-7 above?

  98. If so, how many times or projects during the year not already reported did your camp/lodge volunteer or perform community service or fundraising for?
  99. On the averge, how many members/non-members helped with each project?
  100. How many volunteer hours were spent on these projects in total (total of all members' volunteer time including organizing)?
  101. Camp/Lodge funds spent in support of the project:
  102. Camp/Lodge funds donated:
  103. Description of programs or events: