* Camp/Lodge No.:
* City & State:
* Name of Individual & Position completing the form:
CAMP/LODGE FINANCIAL PROFILE FOR IRS REPORTING:
* Legal Name of Camp/Lodge (name used for bank account):
* Annual Tax Period (calendar or other fiscal period):
* Are camp/lodge annual gross receipts normally $25,000 or less?
* Other names used by Camp/Lodge (if not applicable, type "None"):
* Total amount of camp/lodge gross income for 2009 from all sources including any money raised through fundraising, member donations, dues, interest income, etc.:
* Total amount your camp/lodge donated to non-profit organizations or underserved individuals during 2009 (this amount should include the cost of organizing fundraising events - DO NOT INCLUDE SOCIETY MATCHING GIFTS):
* Did your camp/lodge use the Society's matching gift program in 2009?
If so, what was the total amount of matching you used in 2009?
* List the non-profit oganizations/individuals that your camp/lodge assisted in 2009 whether or not you utilized the Society's matching gifts program (if none, report none):
* Total dollars spent to maintain and operate the camp/lodge in 2009 (this amount should include meeting space rental, postage, printing, utilities, insurance, supplies, advertising, refreshments, etc.):
* Does your camp/lodge own its own building?
OFFICIAL LOCATION OF CAMP/LODGE RECORDS (Normally camp/lodge secretary address or camp/lodge building address, if applicable):
* Officer Name & Position:
* Street Address:
* City, State and Zip:
* Does your camp/lodge have social (non-benefit or insurance) members?
If so, how many social members are in your camp/lodge?
FRATERNAL BUSINESS & SOCIAL ACTIVITIES OR EVENTS:
* 1. Does your camp/lodge have regularly scheduled business meetings?
If so, how many business meetings did you have during 2009?
What was the average attendance per business meeting?
What was the average length of your business meetings (to the nearest whole hour)?
* 2. Did your camp/lodge sponsor social events or camp/lodge fellowship gatherings for members and guests during 2009?
If so, how many member/guest social events did you have during 2009?
What was the average attendance per social event?
What was the average length of your social events (to the nearest whole hour)?
* 3. Did any of your 2009 social activities involve fundraising for your camp/lodge operations or scholarship program?
If so, number of fundraisers for camp/lodge operations in 2009?
If so, number of fundraisers for camp/lodge scholarship program:
* 4. Did any of your 2009 social activities involve youth (e.g. Christmas Party, Picnics, etc. - do not report Join Hands Day Projects here)?
If so, how many activities included youth?
If so, what was the average attendance of youth per activity?
Short description of events including youth:
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 Fall Food Drive, Join Hands Day and Operation Santa's Elves):
If your camp/lodge participated in any community service, fundraising for other non-profit organizations or volunteer activity during 2009, please indicate the areas of focus (check all that apply):
* 1. Did your camp/lodge recruit volunteers through United We Serve at www.serve.gov this past year?
If so, how many volunteers were recruited through this source?
* 2. Did your camp/lodge do a Join Hands Day project in 2009?
If so, how many total members/non-members, including youth, helped with the project?
How many were youth?
How long did the project last (to the nearest whole hour)?
* 3. Did your camp/lodge offer individual or family educational programs or events as part of a local camp/lodge activity in 2009?
If so, how many educational programs or events did you offer?
How many members partcipated in the educational program?
How many non-members participated in the educational program?
How many volunteer hours were spent (total of all members' volunteer time including organizing)?
Description of educational programs or events offered by your camp/lodge:
* 4. Did your camp/lodge support a local education, backpack collection or adopt-a-school program in 2009?
If so, how many programs or projects did you support?
How many schools benefited?
How many classrooms benefited?
How many students benefited?
How many volunteer hours were spent (total of all members' volunteer time including organizing)?
Description of local education, backpack collection or adopt-a-school program:
* 5. Did your camp/lodge participate in the Society's National Member Fall Food Drive in 2009 (please report here even if you submitted a report of your activity on a national member fall food drive reporting form)?
If so, how many pounds of food were collected?
How much clothing or other items were collected (either approximate $ value or weight, if not included in weight above)?
Amount of money donated to local food pantry or food program (including Society matching gift):
Description of food drive event or program:
How many volunteer hours were spent (total of all members' volunteer time including organizing)?
* 6. Did your camp/lodge grant or provide college scholarships in 2009?
If so, how many scholarships did you grant?
What was the total amount of scholarships provided?
* 7. Did your camp/lodge participate in the Society's Operation Santa's Elves in 2009 (please report here even if you submitted a report of your activity on an Operation Santa's Elves reporting form)?
If so, how many gifts were collected for children?
How many children were impacted by your project?
What other items or food were collected through your project?
What was the $ value or weight of the other items collected?
Amount of money donated to local toy or holiday program (including Society matching gift):
Description of Operation Santa's Elves event or project:
How many volunteer hours were spent (total of all members' volunteer time including organizing)?
* 8. Other than monetary donations, did your camp/lodge do any other community service, fundraising for other non-profit organizations or volunteer activities in 2009 not already reported in questions 2-7 above?
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?
On the averge, how many members/non-members helped with each project?
On the average, how long did each project last (to the nearest whole hour)?
Description of programs or events:
Contact Us
Camp/Lodge Reporting
Camp/Lodge Annual Report '09