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rom 990 Return of Organization Exempt From Income Tax ‘Under section 501(), 827, o4947(a() ofthe Internal Revenue Code (except private foundations) 2016 apa aeYraey > Do mot enter social secunty numbers on this form as may be made public Open to Public ‘aan ove D information about Form 990 and ts nsuctions lsat wari gov/orms0, ingpection ‘A For the 2016 calendar year, or tax yoar beginning 7/01/16 and ending 06/30/17 B Oastgleatie [F Mane terran To Ee ion ewww | —__Moodnen Poundation on Nemechoge Rontere eet FO TS TST RE GNSS eS rs nasrn 1700 Farnam Street - Suite 2757 [402-342-1890 eee an [omaha We_68102 ecoswsess 1,729,417 woaiamain| 5. James Patterson Ha teapmpmuntesnodeses; Yer X Wo 1700 Farnam Street MoyAwestateinmeseudar Ye No Omaha NE_68102 Wo ach enn) 1 Teergianes —_X! couse) 21g Mes) aetna ee weet _NZA Me Grup examaton nar A fomalopaain_X]Copoaier Tus _pascauo Loner [erator 2006 [w sundeqacnos NE 1 Summary 1 Brey describe the organizaors mission or most significant actives | See Schedule 0 : 8) 2 Check his tox Bit the organization ciscontinued is operations oF deposed of more than 25% of ts net assets. {| 3 Number of voting members ofthe governing body (Pat Vine ta) a|9 3] 4 Number ofindependent votng members ofthe governing body (Part Vine 16) 413 | _5 Total number of ncividuas employed in calendar year 2016 (Part. ine 20) a) 36 Total numberof volunteers (estimate i necessary) 60 a otal unrelated business revenue from Part Vil column (C). tine 42 71 0 bb Net unrelated business taxable income from Form 990-7, ine 24 : 7 0 rare cea 4g 8 Contnbutons and grants (Part Vi ine 1h) 3,455) 8,520 2 | 9 Program service revenue (Part Vl ne 29) 1,513,583) 1, 424/730 E| 19 tovestmentincome (Pat Vil, column (A), ines 3, 4 ard 74) 2,038 1,916 41 Other revenue (Pat Vl, column (A), ines 5.64, 8c, 9, 106, and tte) 273,034] 167, 684 12 Total revenue — add ines 8 through 11 (must equal Part Vil column (A, ine 1,792,110| 1,602,850 13-Grants and similar amounts pai (Part OX, column (A), ines 1-3) 0 0 44 Benefits pad te or for members (Part IX, column (A), ine 4) 0 0 g | 15 Sslanes, otner compensation, employee benefits (Part X, column (A), ines 5-10) 0 0 £ | 1eaProtesions tran oo (art can (ne 136) 0 0 3) Tota undrasing expenses (Pat IX, column (0), ine 25) o 5) 17 otherexpenses (Part iX, column (A), ines 112-116, 111-240) 2,405,142] 804 418 Total expenses. Add ines 13-17 must equal Part i, column (A), ine 25) 2,405,142] ‘804 49 Revenue less expenses. Subtract ine 1 rom ine 12 613,032] 954 | Beaaingot CurentYeut [Enfant EB 20 otal assets (Par x. ne 16) 12,716,917 331, 9) 21 Tota iabittes (Par x, tne 26) 9,468,705] 077 EEL 22 Net assets or fund balances, Subtract ine 21 rom ine 20 3,248,208) 2,615,254 Parti Signature Block ‘Under penalties of pep dciare tal have examined is rlum eluding accompanying schedles and Salomers, and othe best ol my nowedge and baie Als tre, correct and copiits. Detaratan of preparer (oer han oficr is based ona nermaton of which prepaer Ras ary krowedge, y fe Liza 71 Sign = oor Here | ) “Jordan. Mawson i meen Privacy Redaction Proparer lrmminre > This tax return = Use Only prepared by a fmssims > Ron=paid preparer. Per ‘May he IRS ciscuss this return withthe preparer shown above? (see instructions) Yes |_No For Paperwork Reduction Act Note, se the separate nstuctions Fer 990 (25) Fo 990 (2016) Woodmen Foundation Privacy Redaction Pago 2 Partill Statement of Program Service Accomplishments Check if Schedule © contains a response or note to any line in this Part Il x 1 _ Brey describe the organization's mission: See Schedule 0 2 Did the organization undertake any significant program services during the year which were not listed on the _ prior For 980 or 990.627 Yes K No "Ves," describe these new services on Schedule O. Did the organization cease conducting, or make significant changes in how it conducts, any program services? Yes K No l1"¥es," describe these changes on Schedule ©. 4 Describe the organization's program service accomplishments fr each ofits three largest program services, as measured by ‘expenses. Section 601(c)(3) and 601(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenve, if any, foreach program service reported. ‘a (Code: ViExpensesS 2,266, 5B5_ including grants ofS ) Revenue 1,708,827 ) Working in a cooperative manner with the city and county government in Kinston, NC in running a community center to enhance the quality of life of the community's members through a variety of health and wellness activities, with membership open to the public at rates affordable to a vast segment of the area. ‘4b (Code: V(Eapenses § induding grants ofS ) (Revenue § y ‘e (Code ) (Expenses $ inaluding grants ofS ) (Revenue § ) “4d Giver program senices (Describe Schedule 0) Expenses § including grants ofS Revenue $ de Total program sence expenses 2, 266, 585 DAA Form 990 (20:6) Privacy Redaction Form 990 (2016) Woodmen Foundation. Page 3 PartIV Checklist of Required Schedules Yes] No 1 Is the organization described in section 50'(c)3) or 4947(a}(1) (other than a private foundation)? if "Yes," ‘complete Schedule A i|x 2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? 21x 3 Did the organization engage in director indirect politcal campaign activities on behalf of orn opposition to ‘candidates for public office? If "Yes," complete Schedule C, Part I 3 x 4 Section 501(c)(3) organizations. Did the o-ganization engage in abtying actives, or have a section 50%(h) ‘lection in effect during the tax year? If"Yes," completa Schedule C, Part it 4 x 5 Is the organization a section 501 (c)(4, 501(c)(5). or 801(c)6) organization that receives membership dues, ‘assessments, or similar amounts as defined in Revenue Procedure 98-197 II "Yes," complete Schedule C, Part il 5 x 6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors hhave the right to provide advice on the distribution or investment of amounts in such funds or accounts? If *Yes," complete Schedule D, Part | 6 x 7 Did the organization receive or hold conservation easement, including easements to preserve open space, the environment, historic land areas, or histor structures? IF “Yes,” complete Schedule D, Pat i! z x Did the organization maintain collections of works of art, historical reasures, or other similar assets? If“¥es, ‘complete Schedule D, Part it a x 9 Did the organization report an amount in Part X, line 21, for escrow or custodial account labilly, serve as @ ‘custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or abt negotiation services? If*Yes," complete Schedule D, Part IV 9 x 10 Did the organization, directly or through a related organization, hold assets in temporarily restricted ‘endowments, permanent endowments, or quasi-endowments? if"Yes,” complete Schedule D, Part V 10 x 11 Ifthe organization's answer to any ofthe following questions is "Yes." then complete Schedule D, Parts VI, VIL VX, or X as applicable, {Did the organization report an amount for land, buildings, and equipment in Part X, ine 102 Uf "Yes," ‘complete Schedule D, Part VI sta] X Did the organization report an amount for investments—other securities in Part X, line 12 thal is 8% or more ofits total assets reported in Part X, line 162 IF"Yes," complete Schedule D, Part Vil ato] | x ‘©. Did the organization report an amount for investments—program related in Part X, line 13 tha is 6% or more ofits total assets reported in Part X, line 16? IF Yes," complete Schedule D, Part Vill tte] | X Did the organization report an amount for other assets in Part X, ine 15 that is 5% or more ofits total assets reported in Part X, ine 182 I Yes," complete Schedule, Part IX ata|_| X Did the organization report an amount for other liabilities in Part X, line 257 If*¥es," complete Schedule D, Part X ite| X Did the organization’ separate or consolidated nancial statements for the tax year include a footnote that addresses ‘he organization's lability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X td x 428. Did the organization obtain separate, independent aucited financial statements forthe tax year? IF"Yes," complete Schedule D, Parts XI and Xi! 12a| X Was the organization included in consolidated, independent audited financial statements for tne tax year? IF "Yes," and ithe organization answered "No"to line 12a, then completing Schedule D, Parts X! and XIlis optional s| | xX 13s the organization a school described in section 170(b)(1)ANi)? if "Yes," complete Schedule E 3 x ‘4a_Did the organization maintain an office, employees, or agents outside ofthe United States? a x Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? if "Yes," complete Schedule F, Parts !and IV sa] | X 48 Did the organization report on Part IX, column (A), ine 3, more than $5,000 of grants or other assistance to oF for any foreign organization? f "Yes," complete Schedule F, Parts I! and IV 5 x 46 Did the organization report on Part IX, column (A), ne 3, more than $5,000 of aggregate grants or other assistance to or fr foreign individuals? If Yes," complete Schedule F, Parts Ill and IV 16 x 47 Did the organization report a total of more than $16,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 116? If*¥es,” complete Schedule G, Part (see instructions) a7 x 48 Did the organization report more than $15,000 foal of fundraising event grass income and coniribulons on Part Vil lines 1e and 8a? IF "Yes," complete Schedule G, Part I 6 x 19. _Did the organization report more than $15,000 of gross income from gaming aciviles on Part Vil, ine 83? 11"Yes," complete Schedule G, Part Ul 19 x Foy 990 (2016 Privacy Redaction Form 990 (2016) Woodmen Foundation. Page 4 PartIV___ Checklist of Required Schedules (continued) Yes No. 20a Did the organization operate one or more hospital facilites? if “Yes,” complete Schedule H 20af |X bb 11°Yes" to line 20a, did the organization attach a copy of ts auelted financial statements to this return? 20b 24. Did the organization report more than $5,000 of grants or other assistance to any domestic organization oF domestic government on Part IX, column (A), line 1? If*Yes," complote Schedule |, Parts | and I! 2 x 22 Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? “Yes,” complete Schedule |, Parts | and i! 2 x 23 Did the organization answer “Yes” to Part Vil, Section A, line 3,4, or § about compensation ofthe ‘organization's curcent and former officers, directors, trustees, Key employees, and highest compensated ‘employees? If*¥es," complete Schedule J 2s| x 24a. Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than {$100,000 as of the last day ofthe year, that was issued after December 31, 20027 If Yes," answer lines 240 ‘through 24d and complete Schedule K. IN," goto line 26a 2a x Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 2b Did the organization maintain an escrow account other tan a refunding escrow at any time during the year to defease any tax-exempt bonds? 2c Did the organization act as an “on behalf of issuer fr bonds outstanding at any time during the year? 24d 25a Section 501(¢)(3), 501(¢)(4), and 501(c)(29) organizations. Did the organization engage in an excess benetit ‘transaction with a disqualified person during the year? I"Yes,” complete Schedule L, Part 250 x bb Is he organization aware thatt engaged in an excess benefit transaction with a disqualified parson ina prior year, and thal the transaction has not been reported on any of the arganizaion’s prior Forms 990 or 990E2? 1" °¥es," complete Schedule L, Part | 25 x 26 Did the organization report any amount on Part X, line 5,6, oF 22 for receivables from or payabies to any current o former officers, directors, trustees, key employees, highest compensated employees, or lisqualified persons? If"¥es," complete Schedule L, Part I! 26 x 27 Did the organization provide a grantor other assistance to an officer, director, Wustee, key employee, ‘substantial contributor or employee thereof, a grant selection committee member, or to @ 35% controlled cently or family member of ary ofthese persons? If*¥es, “complete Schedule L, Part Ill ar x 28 Was the organization a party to @ business transaction with one ofthe folowing parties (see Schedule L, Part IV instructions for applicable fling thresholds, conditions, and exceptions) @ Acurrent or former oficer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV 28a x 1b A amily member ofa current or former officer, director, tustee, or key employee? if "Yes," complete Schedule L, Part IV 2b x {© An enity of which a curent or former officer, director, trustee, or key employee (or & family member thereof) was an offcer, director, trustee, or direct or indirect owner? If"Yes,” complete Schedule L, Part IV 2c x 29 Di the organization receive more than $25,000 in non-cash contrbutions? If*Yes," complete Schedule M 29 x 30 Dic the organization receive contributions of ar, historical treasures, or other similar assets, or qualified conservation contributions? If"Yes,”" complete Schedule M 30 x 31. Dic the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part! a x 32 Did he organization sel, exchange, dispose of, or transfer mare than 25% ofits net assets? IF "Yes," ‘complete Schedule N, Part 32 x 33 Did the organization own 100% of an ently disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-87 IfYes," complete Schedule R, Part 33 x 34 Was the organization related to any tax-exempt or taxable entity? If"Ves,” complete Schedule R, Part Il, or lV, and Part V, ine 1 3a| x 35a Did the organization have a controlled entity within the meaning of section 612(6)(18)? 358 x 'b_ If Y¥es"to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b\ 13)? If"Yes,” complete Schedule R, Part V, fine 2 35b 36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? if Yes,” complete Schedule R, Part V, ine 2 36. x 37 Did the organization conduct more than 5% of is actives through an entity thats nat arelaied organization and that is treated as a partnership for federal income tax purposes? "Yes," complete Schedule R, Part vi 37 x 38 Did the organization complete Schedule O and provide expianaiions in Schedule O for Part Vi lines 1 1b and 197 Note. All Form 990 fers are required to complete Schedule O. se] x Fam 990 (2056 Privacy Redaction Form 990 2016) Woodmen Foundation. Page 5 PartV Statements Regarding Other IRS Filings and Tax Compliance ca Check if Schedule O contains a response of note to any line in this Part V Yes| No ‘1a. Enier the number reported in Box 3 of Form 1096. Entor-0- i not applicable tal 0 bb Enter the number of Forms W-2G included inline 1a. Enter -0- if not applicable 0 {© Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winsings to prize winners? te | X 2a Enior the numberof employees reported on Form W-3, Transmit of Wage and Tax Statements, fled for the calendar year ending with or within the year covered by this retum, [2a | O. b Hat least one is reported online 2a, cid the organization file all required federal employment tax returns? 2 Note. the sum of ines 1a and 2ais greater than 250, you may be required to e-file (see instructions) 3a_Did the organization have unrelated business gross income of $1,000 or moce during the year? 3a x b 1(-¥es," has it fled a Form 990-1 fr this year? If No" oline 3b, provide an explanation in Schedule O 3b 44a_A any ime during the calendar year, dd the organization have an interes in, ora signature or other authority ‘over, a financial account ina foreign county (such as a bank account, secures account, oF other financial ‘account? 4a x b1°Yes," enter the name of the foreign county: See instructions for fing requirements for FinEN Form 114, Repor of Foreign Bank and Financial Accounts (BAR). 5a Wias the organization a party to prohibited tax shelter transaction at any time during the tax year? 5a x > Did any taxable party noty the organization that it was or isa party toa prohibited tax shelter transaction? 5 x € "Yes" tlie Sa or 8b, did the organization fe Form 8886-7? Se. 2 Does the organization have annual gros receipts thal are normally greater than $100,000, and did the ‘organization solicit any contibutions that were not tax deductible as charitable contibutions? ba x bb I1°Yes," did the organization include wth every solicitation an express statement that such contibutions of ‘ilts were not tax deductibie? eb 7. Organizations that may receive deductible contributions under section 170(¢). ‘Did the organization receive a payment in excess of $75 made parly as a contbution and party for goods {and services provided tothe payor? Ta bI1°Yes," did the organization notify the donor ofthe value ofthe goods or services provided? 1 © Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was. required to fle Form 82627 Te 4 If*¥es, indicate the numberof Forms 8282 fed during the year 14 © Did the organization receive any fun, direc or ndrecy to pay premiums on a personal benefit conract? te Did the organization, during the year, pay premiums, directly or inirecty, on a personal benefit contract? 7 4. Ifthe organization received contribution of qualified intelectual property, cid the organization fle Form 8899 as required? | 7g fh Hfthe organization received a contribution of cars, boas, airplanes, or other vehicles, did the organization file a Form 1098-C7 | 7h 8 Sponsoring organizations maintaining donor advised funds. Did = donor advsed fund maintained by the sponsoring organization have excess business holdings a ay time durin the year? 8 9 Sponsoring organizations maintaining donor advised funds. {Did the sponsoring organization make any taxable cstrbuions under section 49667 9a Did the sponsoring organization make a distribution toa donor, donor advisor, or related person? 9 40 Section 501(c)7) organizations. Enter {Inittion fees and capital contributions included on Part Vil, ine 12 10a Gross receipts, included on Form 990, Part Vl line 12, for public use of cub fciiies 106| 41 Section 501(c)(12) organizations. Enter Gross income from members or shareholders ta Gross income from other sources (Do not net amounts due or paid io other sources ‘against amounts due or received from them ) 110) 12a. Section 4947(a)(1) non-exempt charitable truss. s the organization fling Form 880 in iu of Form 10817 ta _If*Yes,” ener the amount of tax-exempt interest received or accrued during the year 2b] 13 Section 501(c)(28) qualified nonprofit health insurance issuers. {Is the organization licensed to issue qualified heath plans in more than one state? a Note. See the instructions for additional information the organization must report on Schedule ©, bb Enter the amount of reserves the organization is required to maintain by te states in which the organization is licensed to issue qualified health plans 430] Enter the amount of reserves on hand 136. ‘4a_Did the organization receive any payments for indoor tanning services during the tax year? taal |X bb_If*¥es,"has it fled @ Form 720 to rer these payments? If No, provide an explanation in Schedule O 140 ae Fom 990 2036) Fom 990 (2016) Woodmen Foundation Privacy Redaction Pago 6 Part VI Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for & "No response to line 8a, 8b, oF 10b below, describe the circumstances, processes, or changes in Schedule O, See instructions. ‘Check if Schedule O contains a response or note to any line inthis Part VI x Section A. Governing Body and Management Yes] No ‘1a Enter the number of voting members ofthe governing body atthe end of the tax year {9 I there are material differences in voting rights among members of the governing body, or tue governing body delegated broad authority to an executive commitee of similar ‘committe, explain in Schedule O. Enter the number of voting members included in ine ta, above, who are independent | 3 2 Did any officer, director, trustee, or key employee have family relationship ora business relationship with any other officer, director, tustee, or key employee?” 2 x 3 Did the organization delegate control over management duties customarily performed by or under the direct ssupenision of officers, directors, or trustees, or key employees to 2 management company or other person? 3 x 4 Did the ocganization make any significant changes to its governing documents since the prior Form 990 was filed? 4 x 5 Did the ocganizaton become aware during the year ofa significant diversion ofthe organization's assets? 5 x 8 Did the organization have members or stockholders? 6 x Ta_ Did the organization have members, stockholders, or ether persons who had the power to elector appoint fone oF more members ofthe governing body? ta x Are any governance decisions ofthe organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? to x 8 Did the oxganization contemporaneously document the meetings held or wien actions undertaken during the yearby the folow)ne: ‘2 The governing body? ga| X b Each committee with authority (6 ct on behalf ofthe governing body? ab | X 9 Is there any offoer, director, ustee, or key employee listed in Part Vl, Section A, who cannot be reached at the organization's mailing address? If“Yes,” provide the names and addresses in Schedule O 2 x Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.) Yes| No 10a Did the organization have local chapters, branches, or afitates? 10a x b_If"¥es,” did the organization have written policies and procedures governing the actives of such chapters, affiates, and branches to ensure their operations are consistent withthe organization's exempt purposes? 10 ‘V1a_Has the organization provided a complete copy of this Form 990 to all members of its governing body before fling the for? [44a] b_ Describe in Schedule © the process, if any, used by the organization to review this Form 980. 42a Did the oxgarization have a writen conflict of interest policy? If No," go to line 13, s2a| X b_ Were officers, directors, or trustees, and key employees required to disclose annually interests thal could give rise to conticis? [426] X ‘©. Did the organization regularly and consistently monitor and enforce compliance with the policy? If"¥es," describe in Schedule O how this was done s2e| X 13. Did the organization have a witten whistleblower policy? 3X 44 Did the organization have a witten document retention and destruction policy? a [xX 45. _Did the process for determining compensation ofthe folowing persons include a review and approval by independent persons, comparabilly dala, and contemporaneous substantiation of the deliberation and decision? 12 The organization's CEO, Executive Director, or top management official 158 x b_ Other offcers or key employees ofthe organization ssp[ |X I1"Yes" to line 18a or 1, describe the process in Schedule O (S00 instructions), 46a Did the organization invest in, contribute assets to, or participa ina joint venture or similar arrangement with a taxable entity during the year? 168 x 'b_I"¥es," aid the organization follow a written policy or procedure requiring the organization to evaluate its Participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the ‘organization's exempt status with respect to such arrangements? 16 Section C. Disclosure 417 Ut he slates with which a copy ofthis Form 690 i requed oe fied PAL AR, CA, FE, GA, 1, K¥,MD,MS,NC,NE,NM, NY 18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available fr publ inspection Indicate how you made these availabe. Check al that apply. LL owawebsite [_} Another's webste [X) Upon request |_| Other (expan in Schedule 0) 19 Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements avalale to the public during the tax yea. 20__ State the namo, adress, and telephone number ofthe person who possesses the organization's books and records: S. James Patterson 1700 Farnam Street omaha NE_68102 402-342-1890 ee For 990 (20% Fom 990 (2016) Woodmen_Foundation Privacy Redaction Pago 7 Part Vil Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors ‘Check if Schedule O contains a response or note to any line in this Part Vil ‘Section A Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees ‘a Complete tis table fr al persons required tobe listed. Report compensation forthe calendar year ending with or within the ‘rganzalons tax yer ‘Lista of the organization's current ofcars, directors, tustees (whether individuals or organizations), regardless of amount of ‘compensation. Entor=0-in columns (0) (E), and (F) # no Compensation was paid « List al of the organization's eurrent key employees, ary. See instructions for definition of key employee.” « Lisl the organizaton's five current highest compensated empoyees (ther than an ofcer, director, tuste,o: Key employee) wns recaived reportable compensation (20x 5 of Form W2 andlor Box 7 of Form 1090-MISC) of more than $100,000 fom the Drgenizaton and any related orgenizalions ‘ List all ofthe organization's former officers, key employees, and highest compensated employees who received more than ‘100,000 of reporabie compencation rom te organization and any related orgarzatons. « List all ofthe ogarizaton’s former directors or trustees tha received, nthe capacity as a former director or tustee of the cxgenizaton, more than $10,000 of reportable compensation fom the orgerizaon and any related organizations List persons inthe folowing order: ndvidual Wustees or rectors, inaitutona wustes;oftcrs; Key employees; highest compensated employees: ad former such persons. [L. Check this box if nether the organization nor any related organization compensated any current officer, director, or trustee. «6 o oI o oI ® eee | eee ee | City | Sorts tecomes) = ont Total om continuation sesso Pan Vi Secon 4. Total (ad ines 9a 4) > Taal arb of nailer bina otha no ove wha eave naan SCOTT repre Sonpnsson fh aiaion PO Yes 3. Did the organization list any former officer, director or trustee, key employee, or highest compensated ‘employee on line 187 IFYes," complete Schedule J for such individual 3 x 4 Forany individual listed online 1a, isthe sum of reportable compensation and etter compensation from the ‘organization and related organizations greater than $150,000? If"Yes," complete Schedule J for such individual a[x 5 _ Did any person listed on lina Ya fecelve or eccrie Compensaiion from any unrelated organization or individual for services rendered to he organization? if"Yas," complela Schedule J or such parson 5 x Section B. Independent Contractors ‘1 Complete this table for your five highest compensated independent contractors thal received more than $100,000 of ‘compensation from the erganizalion. Report compensation forthe calendar year ending with or within the organization’ tax yea. ae seen teas cesses conan 2 _ Total numberof independent contracors (wduding but nol inited fo those listed above) who received more than $100,000 of compensation from the organization ° om Fam 990 258 Privacy Redaction 7 Form 990 (2016) Woodmen Foundation. Part Vill Statement of Revenue Check if Schedule O contains a response or note to any line in this Part Vil ‘a Rall or ates Reel Foderaied campaigns. [4a Membership dues tb Fundraising events te Relatod organizations 4d coormrrgars(arttutas) [te ata arate of gr, ‘nosmixarcusrdicidaoe | 4¢ 2,520] Necanertater euitns tit§ fh Total. Add ines 12-11 > 8,520 2a Group Merbexships 631, 884| 631, 884| Hater Park Admissions Ravenve 510,276| 510,276] Individual Memberships 241,991[ 241,993] Community Center 40,579 40,579] {All other program service revenue Total, Add ines 22-21 > | 1,424,730] 3 lvestment income (including dividends, interest, ‘and other similar amounts) > 1,916 1,916 4 Income from investment of tax-exempt bond proceed 5 Royalties > oT Penna 6a Gross rents 105, 603] b Lert ene, © arte 105, 603] 1d. Net rental income or (loss) > 105 , 603] 105,603 7a Gosarartfey (secutes Tower selec este chet Les cxtorat tae a © Gain or (oss 4. Net gain or (058) > 8a Goss incre trom furtaising evets (etinceirgs of cottons repested cnline 1. ‘Soe Pat, ne 18 a b Less: direct expenses » © Netincome or (loss) from fundraising events... 8a. Gossinoare trom gering actives ‘Soe Pat, ne 19 a Less: direct expenses » © Net income or (loss) from gaming activites > 10a Gross sales of inventory, less retums and allowances a 185,232] bb Less: cost of goods sold » 126,567] {¢ Net income or (oss) from Sales of inventory > 58, 665| 58, 665| Other Revenue Tia Personal, Trainer Revenue 3,300] 3,300 b Misceiianeous 91] 91 © _ Returned checks 25| 25] 4 Allother revenue @ Total. Add lines 114-114 > 3, 4i6 12. Total revenue. See instructions, > [7,602,850] 1, 488,727] | 105,603 For 990 (20:8 Fom 990 (2016) Woodmen Foundation. Privacy Redaction Part IX__ Statement of Functional Expenses Section 507(@)(3) and 601/)(4) organizations must complete al colmns. Al other organizations must complete column (A ‘Check l Schedule O contains a response or note to any tine inthis Part DK ¥. Do not inctude amounts reported on tines 66, | roy Snues Pragam eves aneaser sn rundahg 7b, 8b, 96, and 10b of Part Vil ‘Soon seers spe 1 Gare archer asieares barrie orate se cereste games See Pat, 221 2 Grants and other assistance to domestic individuals. See Part IV, line 22 3. Gartsardoher assistance toforign creriations farign qoeerrerts, and forian indvicals. Soo Pat Vines 15 and 16 4 Benefits paid too for members 5 Compensation of current officers, directors, twustees, and key employees {6 Compensation netincued above, io squid parsons (as defined urd scion 495841) are parsons decribed in scten 4258(2¥'318) 7 Other salaries and wages {8 Penscn pen axa and carbons (cde secon 401K) ane a0) enphoyer corte) 9 Otner employee benefits 10. Payrol taxes 11 Fees fr services (non-employees} Management Legal 26, 042| 7, 521| 18,521) ‘Accounting 14,900] 14, 900| Lobbying Ffesinaltucaling saris Soe Pat, ne 17 Investment management fees (he. tine “iganat ect tre 25 earn (arate Ta eperee on SeeckeO) 12. Advertsing and promotion 57,102 57,102 13. Office expenses 1,980] 1,980] 14 Information technology 4,650) 4,650] 15. Royalties 16 Occupancy 17 Travel 2, 916| 128| 2, 788 18. Payments of rave or entertainment expensds for any federal state, or local pubic offal Page 10 419. Conferences, conventions, and meetings 1,195| 1,195] 20. Interest 467,597) 467,597] 21 Payments io afliates 22. Depreciation, depletion, and amortization 424,048] 424,048] 23. Insurance 21,527] 21,527] 24 Cer exposes rigs opens rok covered shove (Ut riscalenecus expenses inline 2. If ne 2te arcunt exceeds 106cf line 25, cdlumn (Aart, istine 24 expenses cn Schede O) a Kinston Service Fees - Pt 441, 926| 441, 926| b Kinston Service Fees - R 142,028] 142,028] © Electric 106,948] 106,948] 4 Service & Maint Contract: 74, 610! 74, 610| @ Allother expenses 448 , 335) 443,347) 4,988) 25 Toll etna expenses. ins 1 nosh 20 2,235,804| 2,209,507] 26,297 0 26 Joint costs. Corrie tis ine ary ifthe ‘agancatonrepmtadin calm cht cos fonacoronedeaoairel carpagiand fering soit Cac ee BL {clin SOP 62 (ASC SB 7 om Fon BBO a) Privacy Redact Form 990 (2016) _ Woodmen Foundation Page 14 Part X Balance Sheet (Check Schedule contains a response or noe fo any tn in this Pan X L (A) ) Beginning of year End of year 1 Cash—non-interest bearing 291,664] 1 304,443 2 Savings and temporary cash investments 92,580] 2 103,286 {3 Pledges and grants receivable, net 99,730] 3 4 Accounts receivable, net 163,911) 4 5 Loans and other ecoivables rom curreni and former ocr, diteclors, twystoes, key employees, ad highest compensated employees Complete Pat I of Schedule L 5 6 Loans and other receivables from cer disqualified persons (a defined under seco 495E\0(1)), persons described in section 4958(¢K.2Y@), and contributing employers afd sponsoring organizations of section 501(¢),) voluniary employees’ beneficiary g| , casnzsions eee nrc). Comte Pat If Sees 6 3| 7 Notes and oans receivable, net z <| 8 Inventories for sale or use 8 9 Prepaid expenses and deterred charges 2 1,508 40a Land, buldings, and equipment: cost or cher basis. Complete Part VI of Schedule D soa] 13,527,337] 'b Less: accumulated depreciation 10b| 1,880,334] 12,029,433] t0c|_ 11,647,003 11) Investments—publy traded secures rn 12. Investments—other secuties. See Part, ine 14 12 13. Investments—programrelated. See Part IV, ne 11 13 14 Iniangiie assets 14 15 Other assets, See Pat iV line 14 39,599] 15 38,091 46 Total assets. Add lines 1 through 15 (must equal line 34) FP By RES ET ee 47 Accauns peyabe and aoctued expenses 96,891] 17 109,315 18 Grants payabie 8 19 Detered revenue 19, 879| 19 17,823 20. Taxexempt bond lstites 20 21. Escrow or custodial account bilty. Complete Part WV of Schedla D 21 22. Loans and other payables to current and former ofcers, directors, | custoes, key employees, highest compensated employees, and | esqualies persons. Complete Part I of Schedule L 2 7/23) Secured mortgages and notes payable to unrelated third parties 23 24 Unsecured notes and loans payable to unrelated third pares 24 25. Other abies nludng federal income tax, payables to relate rd pares, and other labilties not included on ines 17-24. Complete Part X of Schedule D 9,351,939| 25| 9,351,939 26 Total liabilities. Add lines 17 through 25 9,468, 709| 26 9,479,077 ‘Organizations that follow SFAS 117 (ASC 958), check here and complet ines 27 through 2 and tines 33 and 34, B27 Unresvictes net assets 3,148,478 27| 2,615,254 828 Temporary resticted net asseis 99/730] 28 | 20 Permanent rstcied net assets 20 =|" organizations that do not follow SFAS 117 (ASC 966), check here BL] and 5) complete tines 30 through 34 'B|30 Capital stock or trust principal, or current funds 30. 231 Paidsin or capital supus, or and, bulging, or equipment ind 31 3 32 Retained eamings, endowment, accumulated income, or other funds 32 33. Toll not assets or fund balances 3,248,208] 33[ 2,615,254 34 Toll abitios and net assetsund balances 12,716,917 | 12,094,331 Form 990 (2016) Fo 990 (2016) Woodmen _Foundation Privacy Redaction Pago 12 Part XI Reconciliation of Net Assets ‘Check if Schedule O contains a response or note to any line in this Part X/ 1 Total revenue (must equal Part Vill, column (A), ne 12) 4 1,602,850 2. Total expensas (must equal Part IX, column (A), ine 25) 2 2,235,804 3. Revenue less expenses. Subtract ine 2 fom line 1 3 = 632,954 4 Not assets or fund balances at beginning of yaar (must equal Part X, line 33, column (A)) 4 | 3,248,208 Net unvealized gains (losses) on investments 5 6 Donated services and use of facies 6 105,980 7. tvestment expenses z 8 Prior period adjustments 8 =105, 980 9 Other changes in net assels or und balances (explain in Schedule O) 9 410. Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Par; line 33, column (8) 10] 2,615,254 Part XII Financial Statements and Reporting Check if Schedule © contains a response or note to any line in this Part Xi Yes| No 41 Accounting method used o prepare the Form 980: ["] Cah [K] Acenat —] her. ithe organization changed is method of accountng rom prio year oF checked “Other exain in Schedule 0 2a Were the organizations foancial talements compiled or tevewee by an independent accountant? za| |x I1"¥es," check a box below o indicate whether the nancial stalemeis forthe year were compiled or reviewed on a separate basis, consolidated basis, or bth ] seperato basis [_) Consoldated basis [_] Both consoldated and separate basis bb Were the organization's nancial stalements audited by an independent accountant? zo | x I1"¥e8, check a box below oincicate whether the nancial statements forthe year were aut on @ separate basis, consolidated basis, o bth [seperate basis [_) Consoldated basis [_] Both consoldated and separate basis Yes" to tne 28 oF 2b, does the organization have comvitte that assumes responsibly for oversight ‘ofthe audit, review, or compilation of its financial statements and selection of an independent accountant? 2c | X Ifthe organization changed ether its oversight process or selection process during the tax year, explain in ‘Schedule ©. 3a As aresult of a federal award, was the organization required to undergo an auelt or audis as set forth in the Single Aucit Act and OMB Circular A133? 3a bb 11"Yes, id the organization undergo the required audit or audits? ithe organization did not undergo the required ausil or audits, explain why in Schedule O and describe any steps taken to undergo such ausits. 3b Fom 990 2076) SCHEDULE A Public Charity Status and Public Support ‘OM No. 1546-0067 McsubesTohcors) plate ognzton es section £06) rato reson 7a) nonenot hate 2016 Depart ote esi > Attach to Form 990 or Form 990-62, Open to Publle inert Rens > iki sh Shea or DED ai ertirmisk wosgoarsea_| _Iepecion Woodmen Foundation L Part! Reason for Public Charity Status (All organizations must complete this. Privacy Redaction ‘The organization is nota private foundation because itis: (For ines 1 through 12, check only one box.) 1 H ‘A church, convention of churches, or association of churches described in section 170(b)(1)(A)). 2 Aschool descrited in section 170(b)(1\ANi. (Attach Schedule E (Form 990 or 990-£2),) 37) Aosta or a cooperative hospital service organization deseribed in section 170(b\(1\(A) 4 [7 Amedical research organization operated in conjunction with a hospital descrbed in section 170(b) ANH). Enter the hospitals name, city, and state 5 [1] An organization operated forthe benefit of college or university owned or operaied by a governmental unit described in ‘section 170(b)(1)(A}(iv). (Complete Part II.) A federal, state, or local government or govemmental unit described in section 170(b)(1}(A)(v)- ‘An organization that nora receives a substantal part of is support from a governmental unt or rom the general pub dosorbod in section 170(\1}A)(v) (Completo Pat I) ‘community rst described in section 170(H)1\(A)) (Complete Par I.) ‘An agit research organization described in section 170(6)1NANix) operated in conuncon wt a land-grant college or unversty ora nomland grant collage of agrctire (se instructions). Enter the name, iy, and state ofthe callege or Aniverty ‘An organization that normaly receives: (i) mor than 39 1/3 ofits support irom conibions, membership fees, and gross receipts rom actives related to ts exempt hncons subject ocean exceptions, and (2) m0 more than 39 1/3% of Support fom gre investment income and unrelated busioss taxable income (les section 611 ta) fom businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part lll.) ‘An organization organized and operated exclusively to test for public safety. See section 509(a)(4). ‘An organization organized and operated exclsivel forth benef ft perform te functions olor o cary out the purposes ‘fone or more publy supported organizations described in section 608()1) or section S08(a)2). See section 809(a)@). Che in boxin ines 128 trough 120 that cescribes the typ oF supporting organization and complete ines 1.121, and 125 Type A supporing organization operatd,superised, or contol by is supported organization(s), ically by giving the supported organizaon() the power to regulary appt or elect a majoriy ofthe directors or tustees of he Supporing organization. You must complete Part WV, Sections A and B. bb [] Type tA supporting organization supervised or controled in connection with Its supported organization(s), by having carirl or management ofthe suppwing organization vesid inthe same persone that cont or manage te supported organizaon(). You must complet Part V, Sections A and C ¢ [J Type mi functionally integrated. A supporting organization operated in connection with, and functionally integrated with, i eupported organizations) (eee nsiucsons) You must complete Part IV, Sections A,D, and E. LJ Type non-functionally integrated. A supporting organization operated in connacton with i support organization(s) thats not fundlonaly integrated. The organization generaly must saisty a distibutin requirement and en atlentveness, requirement (ee insuctons), You must complete Part, Sections A and D, and Part V. «1 Steck toe itt arganizaton received a wrton determination forte RS ht is Typ, Type, Type funcional wepateg, or Type il norfunctonaly mogrted supporng organization { Entecthe numberof supported organizations co {9 Provide the folowing information about the supiried spartans Tea oped men Wyesfoomnin — [ftwapritn] Watson (aman omen feckcebers — [Relnnrewrd Tienes erie Sete surat cc wen oO 10 & " 2 i @ e © o © Total For Paperwork Reduction Act Notice, see the Tn uctions for Form 980 or 0-EZ. ‘Schedule A (Form 990 or 990-62) 2076 ‘Schedule A (Form 990 or 990-£7) 2016 __ Woodmen Foundation Partil Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) Privaey Redaction Page 2 (Complete only if you checked the box on line 5, 7, or 8 of Part | or if the organization failed to qualify under Part Ill. Ifthe organization fails to qualify under the tests listed below, please complete Part Ill.) Section A. Public Support ‘Calendar year (or fiscal year beginninginy > | __(a) 2072 W205 (2014 205 (2078 (Toul Gifts, grants, contributions, and membership fees received. (D0 not Include any "unusual grants") Tax revenues levied forthe organization's benefit and either paid {oor expended on is behalt The value of services or facities fumished by a governmental unit to the organization without charge Total Add lines 1 through 3 ‘The portion of total contributions by ‘each person (other than a {governmental unit or publicly Supported organization) included on line 1 that exceeds 2% of the amount showin on ine 11, column () Public support. brat ne § fer ine 4 Section B. Total Support (Calendar year (or fiscal year beginninginy > | _(a) 2072, W203 (2014 (205 (@2016 7 8 10 " 2 8 Section C. Computation of Public Support Percentage (Tol ‘Amounts from line 4 Gross income from interest, dividends, payments received on secures loans, Fens, royalties and income from similar Net income from unrelated business ‘activities, whether or not the business is regularly caries on ‘Other income. Do not include gain or loss from the sale of capital assets (Explain in Part Vi) Total support. Add lines 7 through 10 Gross receipls from related activities, etc, (688 instructions) 2 First five years. Ifthe Form 990 is for the organization's fst, second, third, fourth, or ith tax year as a section 501(e)3) corgarization, check ths box and stop here. “4 8 168 b ta 8 Public support percentage Tor 2016 (line 6, column (divided by line 17, alum (A) 4 Public suppor percentage from 2015 Schedule A, Part Il ine 14 15 38 113% support test—2016. ithe organization did not check the box on line 13, and line 14 i $3 1/304 or more, check this box and stop here. The organization qualifies as a pubicly supported organization 33-13% support test—2015. ithe organization did not check a box on ine 13 oF 16a, and line 15 is 33 1/3% or more, check this box and stop here. The organization qualifes as 8 publicly supported organization 110%-facts-and-circumstances test—2016. Ifthe organization did not check a box on line 13, 16a, or 166, and line 14 is, 10% or more, and ifthe organization meets the "facts-and-crcumstances” test, check this box and step here. Explain in Part VI how the organization meets the “acts-and-circumstances" tet. The organization qualfies as a publicly supported organization +10%-facts-and-circumstances test 2015, Ifthe organization did not check a box on line 13, 16a, 16b, oF 17a, and line 15's 10% or more, andi the organization meets the "facts-and-crcumstances” test, check this box and stop here. Exolain in Part VI how the organization meets the "Yacts-and-citcumstances" test. The organization qualifies as a pubiy supported organization Private foundation. Ifthe organization did not check a box online 13, 16a, 180, 17a, or 17, check this box and see instructions > > ‘Schedule A (Form 0 oF S50-EZ) 2076 Schedule A (Form 990 or 9907)2016__Woodmen Foundation ‘Section 509(a)(2) (Complete only if you checked the box on line 10 of Part | or if the organization failed to qualify under Part Il Ifthe organization fails to qualify under the tests listed below, please complete Part I) Partill_ Support Schedule for Organizations Describe Privacy Redaction Pages Section A. Public Support Calendar year (or fiscal year beginning in) > (a) 2012 (b) 2013 (e) 2014 (4) 2015 (e) 2016 (f Total 1 ts gas cine adrentartp ‘ene Cord ny gas) 71,286 1,207,272] 1,087,602] 08,450] 062,295] 5,157,205 2 Grete fomarissong Sidr sos patorre or ees Eemshag nary oonenpat rote 373,364 1,180,777] 940,273] 907,258) 0453921 4,255,064 3. Goss res fem ais tht ae rotan (Trot aoor bosocs und cocen S13 4. Tacrevenues levied forthe orgaizatons beneftand ether paid to or expended on is behall 5 The vale of services or facies {umished by a governmental unio the organization wifvou charge 6 Total dé lines 1 though § T244,750] 2,576,049] 2,027,875] 4,035,708] 1,707,787] 9 a2, 168 7a Amounis included on tines 1,2, and 3 received rom daqualfed persons bb Aout nes 2rd rece femater tan dod prsone ft ocd te greater of $5000 ood tearoart oni 18% Beyer € Add lines 7a and 7 8 Public support. (Subiract ine 7 rom tne 6) 9,432,169 Section B. Total Support Celene yer for iscal year begininginy B | a)20i2 | _w2019 | (zone | (a0 | 2016 [Toul 9 Amounis from tne 6 4,244,750] 2,576,049] 2,027,875] 3,835, 08] 1,727,787] 9,412,169 40a Gossinoare fori didn pyres ered cn orrthsloare et, ‘jets and nccrefemsmiar sarees 99,325| _120,e6s| 110,579] __a25,101| _207,607|__se1,490 Unrelated business taxable income (es Section 51! taxes) rom bushesses aequied ater lune 30,1978 € Ad ines 108 and 100 99,225| _120,a6e| 110,579] __a2s,s01| 207,60] __se1,490 14. Netnore fours ines Severe natin ine 0b hotar arretbetasiens rege caren 42 Otner income, Do not ncide gain or lose rom te sale of capt asso (Gxplanin PartVi) 13. Total support. (Add ines 8, 1, 11, and 12) 2,244,085] 2,704,917] 2,138,454] 3,950,009] 1,025,394] 9,973,659 44 First five year: ifthe Form 950 is forth organization's ra, eecond, thik, fourth, o fh lax year as a sectlon S03(6X) orgaiznton, check hs box and stop here > Section C. Computation of Public Support Percentage 45 Publ suppor percentage for 2016 (Ine 8, column () divided by tne 13, cok (9) we] sam 416 Publ suppor percentage from 2015 Schedule A, Patt Il ine 15 16 % Section D. Computation of Investment Income Percentage 47 Investment income percentage for 2046 (ine 106, cokurn (dived by ne #3, cola () 7 ro 48 Investment income percentage from 2015 Schedule A, Par Il ie 17 18 % 19222 1/9% support teste—2016. the organization did nal check the box on ine 14, and ine 18 is more than 32 19%, an He 17 isnot more than 331%, check this box and stop here. The organization qualies esa publi supported organization x bb 23-72% support tests—2015 the organization did nol check a box on ine 14 or ine 192, and ine 16 is more than 39 19%, and tne 18s not more than 392%, check this box and stop here, The organization quails asa publicly supported organization »O 20 Private foundation. I the organization oi not check & box on line 4,199, 0 19, chac his box and see instructions > ‘Schedule A (Form 950 or 980-EZ) 2076 ‘Schedule A (Form 990 or 990-£7) 2016 _ Woodmen Foundation PartIV Supporting Organizations (Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part |, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.) Section A. All Supporting Organizations Privaey Redaction Page 4 1 3a 10a ‘Ave all ofthe organization's supported organizations listed by name inthe organization's governing documents? If"No,” desenibe in Part VI how the supported organizations are designated. If designated by class or purpose, describe the designation. IFhistoric and continuing relationship, explain. Did the organization have any supported organi under section 509(a)(1) or (2)? If*¥es," explain in Part VI how the organization determined that the supported ‘organization was described in section 509(a)(1) or (2). Did the organization have a supported organization described in section 501(c(4), (5), oF (6)? IF*¥es," answer (6) and (c) below. Did the organization confirm that each supported organization qualified under section 501(c)4), (6), or (6) and satistod the public suppor tests under section 509(a}(2)? If "Yes," describe in Part VI when and how the ‘organization made the determination Did the organization ensure that all support to such organizations was used exclusively for section 170(¢)(2\2) purposes? if "Yes," explain in Part VI what controls the organization putin place to ensure such use, ‘Was any supported organization not organized inthe United States (foreign supported organization"? if "Yes," and if you checked 12a or 12b in Part |, answer (b) and (c) below. Did the organization have ultimate control ane discretion in deciding whether to make grants to the foreign supported organization? if"Yes,” descrite in Part VI how the organization had such contol and discretion dospite boing controlled or supervised by or in connection with its supported organizations Did the organization support any foreign supported organization that does not have an IRS determination ‘under sections 501(c)3) and 509(a)1) oF (2)? f "Yes," explain in Part VI what controls the organization used {0 ensure that all support fo the foreign supported organization was used exclusively fr section 170(0)2)(B) purposes. Did the organization add, substitute, or remove any supported organizations during the tax year? if "Yes, answer (b) and (c) below (applicable). Also, provide detail in Part VI, including () the names and EIN ‘numbers ofthe supported organizations added, substituted, or removed; (i) the reasons for each such action; (i) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment tothe organizing document) ‘Type lor Type Il only. Was any acided or substituted supported organization pat of a class already designated inthe organization's organizing document? ‘Substitutions only. Was the substitution the result ofan event beyond the organization's control? Did the organization provide support (whether in the form of grants or the provision of services or facilites) to anyone other than () its supported organizations i individuals that are part ofthe charitable class benefited by one or more of is supported organizations, or i) other supporting organizations that also support or benefit one oF more of the fling organization's supported organizations? if "Yes," provide detain Part VI. Did the organization provide a grant, loan, compensation, or other sinilar payment to a substantial contributor {efined in section 4958(¢)3)(C), a family member ofa substantial contrutor, or a 35% controled entity with regard to a substantial contributor? If "Yes," complete Pat fof Schedule L (Form 990 or 990-EZ) Did the organization make a loan to a disqualified person (as defined in section 4958) not described in ine 7? 11°Yes," complete Part | of Schedule L. (Form 990 or 990-EZ). Was the organization controled directly or indrecty at any time during the tax year by one or more squalid persons as defined in section 4946 (other than foundation managers and organizations described In section £09(a)1) or (2))? If "Yes," provide detain Part Vi. Did one or mare disqualified persons (as defined inline Ga) hold a controling interest in any entty in which the supporting organization had an interest? If "Yes," provide detain Part VI. Did a disqualified porson (as defined in line $a) have an ownership interest in, or derive any personal benefit fom, assets in which the supporting organization also had an interst? /f "Yes," provide detail Part VI. \Was the organization subject tothe excess business holdings rules of section 4943 because of section 4943( (regarding certain Type Il supporting organizations, and all Type Il non-unctionally integrated ‘supporting organizations)? if "Yes," answer 10b below. Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, o determing whether the organization had excess business holdings.) tion that does not have an IRS determination of status Yes | No ab ae 4p 4c 50 2 9. 40a 406 ‘Schedule A (Form 990 or 950-EZ) 2076 Senet iz men Foundation Privaey Redaction ns (continued) (For 990 or 990-62) 2016 __ We fart IV Supporting Organizat Page 5 " Yes Has the organization accepted a git or contribution trom any ofthe following persons? '@ Aperson who dtecly or Indirectly contrals, ether alone or togather with persons deserbed in (b) and (c) bolow, the governing body of a supported organization?” Ma 1b A family member of a person described in (a) above? tb ‘A 35% controlled entity of a person described in (a) or (b) above? "Yes" toa. b, orc, provide detain Part Vi. ie Section B. Type | Supporting Organizations 1 Yes No Did the directors, trustees, or membership of ane or more supported organizations have the power to regularly appoint or elec at least a majority ofthe organization’ directors or vustees at all times during the {ax year? If"No," desenbe in Part VI how the supported organization(s) effectively operated, supervised, or Controlled the organization's actives. Ifthe organization had more than one supported organization, describe how the powers fo appoint andjor remove direclors or trustees were allocated among the supported ‘organizations and what conditions or restrictions if any, applied to such powers during th tax year 1 Did the organization operate forthe benefit of any supported organization other than the supported ‘organizaton(s) that operated, supervised, of controlled the supporting organization? If"Yes," explain in Part Vi how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controled the supporting organization, 2 Section C. Type Il Supporting Organizations 1 Yes. Were a majorty ofthe organization's directors or trustees during the tax year also a majorly ofthe directors for trustees of each ofthe organization's supported organization(s)? If ‘No," describe in Part VI how control ‘or management ofthe supporting organization was vested inthe same persons thal controled or managed the supported organization(s) 4 Section D. All Type Ill Supporting Organizations 1 Yes Did the organization provide to each of ts supported organizations, by the last day ofthe ith month of the ‘organization's tax year, (i) wrttan notice describing the type and amount of support provided during the prior tax ya, (i) a copy ofthe Form 990 that was most recently filed as ofthe date of natifcation, and (ii) copies of the ‘organization's governing documents in effect onthe date of notification, tothe extent not previously provided? 4 Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (i) serving on the governing body of @ supported organization? if No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s). 2 By reason of the relationship described in (2), did the organization's supported organizations have & significant voice in the organization's investment policies and in directing the use of the organization's income or assets at all times during the tax year? If "Yes," describe in Part VI the roe the organization's “supported organizations played in this re 3 Section E. Type ill Functionally-Integrated Supporting Organizations 1 2 Check the box next to the method thatthe organization used fo satisfy the Integral Part Test during the year (see Instructions) 2 [_) The organization satisfied the Activities Test. Complete line 2 below, b [The organization isthe parent ofeach ofits supported organizations. Complete line 3 below, ¢ [1 The organization supported a governmental entity. Describe in Part VI how you supported a goverment entity (see instructions) Aciviies Test. Answer (a) and (b) below. Yes No {2 Did substantial all ofthe organization's activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? IF"Yes,"then in Part VI identity, those supported organizations and explain how these activites drecty furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantial al ofits activites. 2a b_ Did the activites desorbed in (a) constitute actives that, but forthe organization’s involvement, one oF more ‘ofthe organization's supported organization(s) would have been engaged in? if "Yes," explain n Part VI tho ‘reasons forthe organization’ postion that ts supported organization(s) would have engaged in these activities but forthe organization's involvement 20 Parent of Supported Organizations. Answer (a) and (b) below. {Did the organization have the power to regularly appoint or elect a majoy ofthe officers, directors, oF trustees of each of the supported organizations? Provide details in Part VI. 3a 'b_ Did the organization exercise a substantial degree of direction over the policies, programs, and actives of each ‘ofits supported organizations? iM*¥es," describe in Part VI the role played by the organization in this regard. 3b. ‘Schedule A (Form 990 or 950-62) 2076 Schedule A (Form 990 or 9902)2018__ Woodmen Foundation Ca linnamcien PartV___ Type ill Non-Functionally Integrated 509(a)(3) Supporting Organizations + [[@heck here (the organization satisfied the Integral Par Test as a qualifying trust on Nov. 20, 1970 (explain in Parl Vi) See Instructions. Al other Type Il non-functional integrated supporting organizations must complete Sections A through E (8) Current Year optional) ‘Section A - Adjusted Net Income (A) Prior Year Nol short-term capital gain Recoveries of prior year distributions ‘Other gross income (see instructions) ‘Add lines 1 tough 3, Depreciation and depletion Portion of operating expenses paid or incurred for production or callection ef gross income or for management, conservation, of maintenance of property held for production of income (see instructions) 7_ Other expenses (see instructions) ‘8 Adjusted Net Income (subtract lines 6, 6 and 7 rom ine 4) 3 (8) Curent Year ‘Section B - Minimum Asset Amount (A) Prior Year optional) 1 Aggregate fair market value ofall non-exemptuse assets (see instructions for shor tax year of assets held for part of year} ‘a Average monthly value of securities ry ‘Average monthly cash balances tb Fair market value of other non-exempt-use assets te Total (a0 lines 1, 1b, and to) 1d Discount cisimed for blockage or other factors (explain in detail Part VL 2 Acquisition indebledness applicable fo non-exempl-use assets ‘3 Subtract line 2 from line 1 ‘4 Cash deomed held for exempt use, Entor 1-172% of line 3 (for greater amount 00 instructions '5__Net value of nomexempt-use assets (sublract ine 4 from line 3) ‘6 Mutiply line 5 by 035. 7_Recoveries of prior-year distributions '8Minimum Asset Amount (addline 7 ne 6) Section C - Distributable Amount Current Year 11_Adjusied net income for prior year (rom Section A ine 8, Colurmn A) 2 Enter 85% of ne 1 '3_ Minimum asset amount for pior year (fom Section B, line 8, Column A) 4 Enter greater of line 2 oF line 3 5 6 Income tx imposed in pr year Distributable Amount. Subact ine 5 rom ine 4 unless subject emergency temporary ruston (se marion) 6 7” [Check her the curent year is the organization's frst a anon funcbonaly wiegrated Type Ii supporng organization (sce insuctons) ‘Schedule A (Form 990 or 990-EZ) 2076 ‘Schedule A (Form 990 or 990-£7) 2016 __ Woodmen Foundation PartV__ Type ill Non-Fun nally Integrated 509(a)(3) Suppor ‘Section D = Distributions 1 2 ‘Amounts pai to supported organizations to accomplish exempt purposes "Amounts paid to perform activity that directly furthers exempt purposes of supported ‘organizations, in excess of income from activity ‘Administrative expenses paid to accomplish exempt purposes of supported organizations ‘Amounts paid to acquire exempluse assets Qualiled set-aside amounts (prior IRS approval required) ‘Other distributions (describe in Part Vi). See instructions. Total annual distributions. Add lines 1 through 6. Distributions to attentive supported organizations to which the organization is responsive provide details in Part Vi), See instructions Distibutable amount for 2016 from Section C, line 6 Privaey Redaction ig Organizations (continued) | Page 7. ‘Current Year Line 6 amount divided by Line 9 amount w Excess Distributions w Underdistributions Pre2016 i Distributable Amount for 2016 Distibutable amount for 2076 from Section C, ine 6 Underaistrioutios, if any, for years prior to 2016 (reasonable cause required-explain in Part VI). See instructions Excess distributions carryover, any, to 2016) From 2013 From 2014 From 2015 Total of ines 3a through & ‘Applied to underdistibutions of prior years ‘Applied to 2016 distributable amount ‘Caryover from 2011 not epplied (see instructions Remainder. Subtract lines 39, 3h, and 3 from 3t Distributions for 2016 from Section 0, ine 7: s ‘Applied to underdistibutons of prior years ‘Applied to 2016 distributable amount Remainder. Subiract lines 4a and 4b from 4 Remaining underdstioution for years prior to 2016, F ‘any, Subtract lines 3g and 4a from line 2. For result greater than zero, explain in Part VI See Instructions. Remaining underdistrioutions for 2016, Subtract lines 3h ‘and 4b from line 1. For result greater than zero, explain in Part VI. See instructions Excoss distributions carryover to 2017. Add ines 3} ‘and 4o, Breakdown of ne Excess from 2013 Excess from 2014 Excess from 2015 Excess from 2016 ‘Schedule A Form 950 or S90EL) 2076 Schedule A (Form 990 or 9907)2016__Woodmen Foundation ae linnacion Page Part VI Supplemental Information. Provide the explanations required by Part Il, line 10; Part Il, ine 17a or 17b; Part Ul line 12; Part lV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part lV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.) ox ‘Schedule A (Form 950 or 980-EZ) 2076 ‘Schedule B (Form 990, 990-£2, Schedule of Contributors or000-P) Attach to Form 990, Form 990-€2, or Form 990-PF. 2016 Pigewancrns Tee” bf information about Schedule (Form 990 90-E7 or 90-PF) ands instructions is at ww. goviformOop. Name of the organization T Emolover identification number Woodmen Foundation Privacy Redaction L Organization type (check one): Firs of Section: Form 990 or 990-£2 FR] s01(cX 3) (enter number) organization 1) 49471) nonexemptchartable ust not weated as a private foundation (1 827 potical erganization Fom 990-0 71 s01(¢ya) exempt private foundation [Cy 49471) nonexempt charitable rust reated asa private foundation L) 50149 exabe private foundation ‘Check f your organization is covered by the General Rule or a Special Rule. Note: Only a section 50%(c}(7), (8), or (10) organization can chack boxes for both the General Rule and a Special Rule. See instructions, General Rule [K} Foran organization fling Form $00, S60-E2, or 990-PF that receive, during the year, conrbutons totaling $5,000 «2¢ more (r money 0" property) om anyone catrbutr. Complete Pat and I See instructions for determining @ contbutor' total controutons Special Rules [L) Foran organization deserted in socton 501(S) fing Form $90 or 99042 that mat he 33 Suppor test of the regulations under sections §09(a)(1) and 170(b)(1(AXvi), that checked Schedule A (Form 990 or 990-EZ), Part Il, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% ofthe amount on i) Form 990, Part Vl re 1, o (i Frm 9902, ine 1. Compete Parts | and LL For an organization described in section 501(c)7) (8), or (10) fing Form 990 or 980+EZ that received from any one Contributer, during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, oF fr the prevention of cruelly to children or animals. Complete Parts Il, andl LL] Foran organization deserbedin secon S01(6K7), 8, or (10 ng Form 990 880-22 tat received fom anyone contributor dung the year, contrbutons exclusively for egos, chartable, et, purposes, bu no such contribs italed more than $1,000 tis box s checked, enter hee te ital contbutons that were received during te year or an excusivly religous, charade, et, purpose, Da compete any ofthe parte ures the Caneral Rule apple to hs organization because i received nonexcushalyrokgius, carta, et, contibutlons toting $5,000 or more during the year ms Caution: An organization that isn't covered by the General Rule andior the Special Rules doesnt file Schedule B (Form 990, .900-EZ, or 990-PF), butit must answer "No" on Part IV line 2, of its Form 890; or check the box on line H of ts Form 990EZ or on its Form 990-PF, Part | ine 2, to cerily that it doesnt meet the fing requirements of Schedule B (Form 990, 990-E2, or 990-PF). For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF ‘Schedule B (Form 990, 90-EZ, or 990-PF) (2016) ‘Schedule B (Form 990, 990-67, or 900-PF) (2016 Name of organization Woodmen Foundation Privacy Redaction Page 1 of 1 Page 2 Emplover identification number ivacy Redaction Part! Contributors (See instructions). Use duplicate copies of Part | if addition, @ oO © @) No. Name, address, and ZIP +4 Total contributions ‘Type of contribution 1 Holly Jolly Holiday Show Person 2602 W Vernon Ave Payroll 8,520, | Noncash Kinston NC 28504 (Complete Part I for rnoneash contributions.) @ o @ @ No. Name, address, and 21P +4 Total contributions ‘Type of contribution Person Payroll Noneash (Complete Parti for rnoneash contributions ) @ © @ @ No. Name, address, and ZIP + 4 Total contributions ‘Type of contribution Person [| Payroll Noneash [7 (Complete Part Il for roncash contributions.) @ ® o @ No. Name, address, and ZIP + 4 Total contributions Type of contribution Person | | Payroll Noncash 7) (Complete Parti for roncash contributions.) @ o @ No. Name, address, and ZIP +4 Total contributions Type of contribution Person [| Payroll Noncash (Complete Part Il for rnoncash contributions ) @ ( © @ No. Name, address, and ZIP +4 Total contributions Type of contribution Noneash (Complete Part for rnoncash contributions.) ‘Schedule B (Form 890, 90-E2, or 990-PF) (2016) SCHEDULE D Supplemental Financial Statements [_owane.ssasooe7 (Form 990) © Complete ifthe organization answered "Yes" on Form 390, 2016 Part Valine 67,8, 9, 10, 11a, 11b, 11e, 14, te, 11, 12a, oF 12b. > Attach to Form 990. ‘Open to Public Information about Schedule D (Form 990) and its instructions is at www.irs.goviformogo, | _Inspection. Woodmen Foundation Privacy Redaction L Part! Organizations Maintaining Donor Advised Funds or Other Similar Fu. eS ‘Complete if the organization answered "Yes" on Form 990, Part IV, line 6. (oor and de Func nares Total number at end of year Aggregate value of contibuions to (during year) ‘Aggregate value of grants from (during year) ‘Aggregate value at end of year Did the organization inform all donors and donor advisors in writing thatthe assets held in donor advised {funds are the organization's property, subject tothe organization's exclusive legal contol? Yes [| No {6 Did the organization inform all grantees, donors, and donor advisors in wring that gran funds can be used ‘only for charitable purposes and not forthe benefit ofthe donor or donor advisor, or for any other purpose conferring impermissible prvate benefit? yes [| No Partll Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7. 1 Purpose(s) af conservation easements held by the organization (check al that apply) [L, Preservaton of ane for pubic se (2.9, recreaton or education) |_| Preservation of ahstorialy important and area Protection of natural habitat © Presaraton of carted histor structure Preservation of open space 2. Complot ines 2a though 28 ha organization held qualifies conservation cantibuton inthe form ofa conservation, fasement on tho ast Say ofthe tax year dat tho End af th Tx Yoar 8 Total numberof conservation easements a Toll acreage restricted by conservation easements 2b «Number of conservation easements on cart hisioric ile incided in (@) 26 4. Number of conservation easements included inc) acquired after 87/0, ad not ona Fistor stuctr stein the National Register 2a 3. Number of conservation easements modified, raster, released, exingushed, or eminaied bythe organizaion ching the taxyear® 4 Number of states where property subject to conservation easement is located Does the organization have a writen policy regarding the periodic monitoring, inspection, handling of Violations, and enforcement of the conservation easements it holds? LH ves [| No 6 Staff and volunteer hours devoted lo monitoring, inspecting, handling of violations, and enforcing conservation easements during the year > 7 Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year Ds '8 Does each conservation easement reported online (4) above satisty the requirements of section 170(hK4)B)() ‘and section 170(h)8KBNi? [ves [] no 9 InPart XII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, if applicable, the text ofthe footnote tothe organizations fnancial statements that describes the ‘organization's accounting for conservation easements PartIll Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. ‘a Ifthe organization elected, as permitted under SFAS 116 (ASC 958), not to repor in is revenue statement and balance sheet Works of ar, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Pat XIl, the text ofthe footnote to ts nancial statements that describes these items. bb ITthe organization elected, as permitted under SFAS 116 (ASC 958), to reportin its revenue statement and balance sheet orks of art, historical treasures, or otter similar assets held for public exhibition, education, or research in furtherance of public service, provide the folowing amounts relating to these items: (Revenue included on Form 990, Part Vl ine 1 »s (il) Assets included in Form 990, Part x ms 2. Ifthe organization received or held works of ar, historical ireasures, or othe similar asseis Tor financial gain, provide the following amounts required tobe reported under SFAS 116 (ASC 956) relating to these items: ‘@ Revenue included on Farm 990, Part Vl ine 1 >s bb_Assets included in Form 990, Pat X > s For Paperwork Reduction Act Notice, see the Instructions for Form 990. ‘Schedule D (Form 990) 2016 ‘Schedule 0 (Form 990) 2016 Woodmen Foundation Privacy Redaction Pago 2 Part Ill Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued) ‘3 Using the organization's acquistion, aocession, and other records, check any af the fllowing that are a signfleant use of is Callecion items (check all that apo): 2] Put exbiion 4 [Loan or exchange programs Scholarly research «C1 oer L] Preservation for ire generations 4 Provide a descrintion of the organizations collections and explain how they further the organizations exempt purpose in Part Xi 5 During the year, tho ganization solct or receive donations of at historical treasures, or other similar oo assets io be sod to raise funds rather than to be mainland as part ofthe organization's colecion? yes [| No PartlV Escrow and Custodial Arrangements. ‘Complete if the organization answered "Yes" on Form 990, Part IV line 9, or reported an amount on Form 990, Part X, line 21 ‘a Is the organization an agent, trustee, custodian or olher intermediary for contributions or other assets not included on Form 990, Part X? bb 11°Yes,’ explain the arrangement in Part Xl and compiate the folowing table: Yes [| No “Amount Beginning balance [Additions during the year Distributions during the year Ending balance 2a Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account iabilty? Yes |_| No bb If"Yes," explain the arrangement in Part XII Check here ifthe explanation has been provided on Part Xl PartV Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV. line 10. a) ert yee (Frere (eTwoywrs tect | (@Tesyeom tack [Fou jorbo 4a Beginning of year balance 'b Contributions © "Not investment earings, gains, and losses 4. Grants or scholarships ‘© Other expenditures for facilities and programs Administrative expenses 9 End of year balance 2 Provide the estimated percentage ofthe current year end balance (line 7g, column (a)) held as: ‘8 Board designated or quasiendowment % bb Permanent endowment D> % © Temporarily restricted endowment % ‘The percentages on lines 22, 2b, and 2c should equal 100%, 3a Are there endowment funds not in the possession ofthe organization that are held and administered for the ‘organization by: Yes | No. () unrelated organizations EO) (i) related organizations 0) 'b If"Yes" online 3a(i), are the related organizations listed as required on Schedule R? 3b 4_Describe in Part Xill ne intended uses ofthe organization's endowment funds, Part VI Land, Buildings, and Equipment. Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10. mpl ery (eCortraerness |) Gator on ane (0 ona coors Ta Land = Si fos6s ae 511,399 » Buikings 12,382, 392| 1,405,799] 10,976,593 ¢ een ne 633,546] 474,535) 59,011 r————— > _ii, 647,003 ‘Schedule 0 (Form 990) 2016 Privacy Redaction ‘Schedule D (Form 990) 201 Woodmen Foundation Part Vil_ Investments—Other Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12. (0) Despont cay rg (eBook a Te) Men fa tng name tee Coster andar your mane ae Page 3 @ Financial derivates (2) Closely-held equity interests ©) Obwr “ ®) ©) ©) ©) €) 8) , Tota. (Column (b) mist equal Form 990, Pat x, col (B) line 12) Part Vill Investments—Program Related. Complete if the organization answered “Yes” on Form 990, Part IV, line 1c. See Form 990, Part X, line 13, (a) Dern mestent 1m) Bena {e)Mened ot atn: @ 2) @) a) 6) ©) @ @) ) Total. (Column (B) must equal Form 990, Part X, col (B) ine 13) PartIX Other Assets. Complete if the organization answered “Yes” on Form 990, Part IV, line 11d. See Form 990, Part x, line 15. () Deepen (Boake a 2) @) ) 6) ©) ©) ®) Total, (Column (B) must equal Farm 990, Part, col. (B) Ine 15, > PartX Other Liabilities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25. i (a) Deszipon aa wyaeavane ()) Federal income taxes @) Mortgage Payable 9,351, 939| @) 4) 6) © @ @) @) ‘Total. (Column (B) must equal Farm 990, Part X, col (B) Ine 25) 9,351, 939| 2. Liability for uncertain tax positions. In Part Xlll, provide the text ofthe footnote to the organization's financial statements that reporis the ‘organization's Habit for uncertain tax postions under FIN 48 (ASC 740), Check here if th text ofthe footnote has been provided in Part Xi ak ‘Schedule 0 (Form 990) 2016 Privacy Redaction Schedule 0 (Form 990)2016 Woodmen Foundation Page 4 Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered "Yes" on Form 990, Part IV, line 12a 1 Total revenue, gains, and otver support per audited financial statements 1 1,708,830 2. Amounis included on ine 1 but not on Form 990, Part Vl line 12; Net unrealized gains (losses) on investments 2a bb Donated services and use of facilites 2b 105, 980) © Recoveries of prior year grants 26. 4 Other (Describe in Pat XII.) 2d © Add nes 2a through 2d 20 105,980 3 Subiract line 2e fom line 4 3| 1,602,850 4 Amounis inchided on Form 990, Per Vil line 12, bul not on ine 1 Investment expenses not included on Form 990, Part Vl lin 7 4a » Other (Describe in Part XL) a © Add lines 4a and 4b eo Total reverve. Ad tines 3 and de. (This musi equal Form 890, Parti tine 12) 5 | 1,602,850 Part Xil_ Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered "Yes" on Form 990, Part IV, line 12a 1 Total expenses and losses per aucited financial statements 1] 2,341, 784 ‘Amounts inchided online 1 but not on Form 990, Pat IX, tine 25: 1 Donated services and use of facilites 2a 105, 980) bb Prior year adustments 2b © Otterlosses 2e. 4 Other (Deserive in Part Xi.) 2d © Add lines 2a through 2d 2e 105,980 3 Subtractline 2e from ine 4 3 | 2,235,804 4 Amounts inchided on Form 990, Part IX. line 25, But not online 1 2 Investment expenses not included on Form 990, Part Vl line 7b fa bb Other (Describe in Part XII) ‘a © Add lines 4a and 4b 4c 5 Total expenses. Add ines 3 nd 4. (This must equal Form 980, Part in 18 5 | 2,235,804 Part Xill_ Supplemental Information. Provide the descriptions required for Part I, ines 3, 5, and 8; Par I, ines 1a and 4 Part, lines 1b and 2b, Pan V, line 4; Part X, tne 2; Part Xl, lines 2d and 4b; and Part Xl, ines 2d and 4b. Also complete this pat to provide any additional information ‘Seiedule 0 (Form 950) 2016 ‘Schedule D (Form 990) 2018 Woodmen Foundation Privacy Redaction Part Xill_Supplemental Information (continued) Pago 5 ‘Schedule 0 (Form 990) 2016 SCHEDULE J Compensation Information aN. 1845.007 aa For cartain Officers, Directors, Trustees, Key Employees, and Highest 901K ee Compersated Employees 2016 > Complete ifthe organization answered "Yes" on Form 980, Part V, line 23. \ Geet Pupne 7 cept Testy attach to Form 90. Ptnapection | tana ven Sean, Prinformation about Schedule J (Form 990) and its instructions Is at www.irs.gov/form900. inspection —____Woodmen Foundation 0000 L Pa ‘Questions Regarding Compensation Privacy Redaction c ‘a Check the appropriate box(es) Ifthe organization provided any ofthe folowing to or fora person listed on Form £990, Part Vil, Section A, line 1a. Complete Part Il to provide any relevant information regarding these items. Fistciass or charter travel [J] Housing allowance or residence for personal use ‘Travel for companions T Paymants for businass use of personal residence ‘Tax indemnification and gross-up payments [F Health or social cub dues or inition fees Discretionary spending account 7) Personal services (such as, maid, chautfeur, chef) bb Hany ofthe boxes online ta are checked, dd the organization follow a wren policy regarding payment (or reimbursement or provision of al ofthe expenses described above? If "No," complete Part Il to explain te 2. Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all directors, trustees, and officers, including he CEO/Executve Director, regarding the items checked inline ta? 2 3 Ingicate which, i any, ofthe following the fling organization used to establish the compensation ofthe ‘xganizaion's CEOVExecutve Director. Check all that apply. Do nt check any boxes for methods used by & related organization to establish compensation ofthe CEO/Executve Director, but explain in Part I [L) Compensation commitee [| Witten employment contract [F tndependent compensation consuitant Compensation survey or study F Form 990 of other organizations 7) Approval by the board or compensation commitiee 4 During the year, did any person listed on Form 990, Part VIl, Section A, line 1a, with respect to the fing ‘organization ora related organization 1 Receive a severance payment or change-of-contol payment? 4a 'b Participate in, or receive payment from, a supplemental nonqualifed retirement plan? ‘tb «Participate in, or receive payment from, an equiy-based compensation arrangement? 4c 11 "Yes" to any of lines 4a-<, lst the persons and provide the applicable amounts for each tem in Part Ii ><|>e oe Only section 501(6)(3), 504(6)(4), and 504(¢){28) organizations must complete lines 5-9. '5. For persons listed on Form 980, Part Vil, Section A ine 18, did the organization pay or accrue any ‘compensation contingent onthe revenues of ‘8 The organization? 5a b Any related organization? 5b I"Yes" on tine 5a or 5b, describe in Par Il >) {6 Forpersons listed on Form 990, Part Vl, Section A ine 18, did the organization pay or accrue any ‘compensation contingent onthe net earnings of ‘8 The organization? 6a 'b Any related organization? 6 I8"Yes" on tine 6a or 6b, describe in Part Ii > >< 7 For parsons listed on Form 980, Part Vil, Section A, line 1a, did the organization provide any nonfxed payments not described on lines 5 and 6? If Yes,” describe in Part I z x 8 Were any amounts reported on Form 990, Part Vil, paid or accrued pursuant to a contract that was subject to the inal contract exception described in Regulations section 53.4958-4(a)(3)? I-Yes,” describe in Part 8 x 9 "Yes" on ine 8, did the organization aso follow the rebuttable presumption procedure described in Regulations section §3.4956-6(c)?, 9 For Paperwork Reduction Act Notice, see the Instructions for Form 990. ‘Shed J orm 90) 2016 Schedule J (Form 960) 2016 _Woodmen Foundation Parti Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row {i} and from related organizations, described inthe instructions, on row i), Do not ist any individuals that aren‘ sted on Form 990, Part Vil Note: The sum of colurmns (B)(-(i) for each listed individual must equal the total amount of Form 990, Part Vl, Section A, line 12, applicable column (D) and (E) amounts for that individual Privacy Redaction Page 2 (A) Name and Title [B)_Breakcown of W-2 andior 1098-MISC compensation] 8 1) Bone 8 oer 16) Retramonc and 10) Noasabie {© Teal ctoounns |) Comparatin (PX) | mesa eens Sereda J Form 990) 2006 Schedule J (Form 990) 2016_Woodmen Foundation tines enncuen Part Ill Supplemental Information Provide the information, explanation, or descriptions required for Part |, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part Il. Also complete this part for any additional information. Part III - Other Additional Information All compensation of Officers and Directors is reported on the Form 990 filed by Woodmen of the World Life Insurance Society (FEIN 47-0339250) . Due to timing S. James Patterson's compensation will be reported on Woodmen, of the World Life Insurance Society's 2017 Form 990. ‘Sehedle Form 90) 2016 ‘SCHEDULE O Supplemental Information to Form 990 or 990-EZ Se tPomab or 20022 Comps oro ntamatonforesporteste sec qtestions on rove or 0082 orto prove y stot inteaton 2016 are > ach Form 0 902 Open o Public SERTREESCIS” maton abut Shel 0 (om SHEE and nsuctons st wn govtemsy. Pepeston Woodmen Foundation Privaey Redaction _ Form 990 - Organization's Mission Working in a cooperative manner with the city and county government in Kinston, NC in running a community center, to enhance the quality of life of the community's members through a variety of health and wellness activities, with membership open to the public at rates affordable to a vast segment, of the area. Form 990, Part VI, Line 11b - Organization's Process to Review Form 990 The Form 990 is prepared and reviewed by professional staff. The Form 990 is then forwarded to the Board of Directors for review prior to final signature and filing of the return. Form 990, Part VI, Line 12c¢ - Enforcement of Conflicts Policy. An annual conflict of interest questionnaire is provided to all officers. and directors and the completed/signed forms are maintained in Woodmen Foundation's records. Form 990, Part VI, Line 17 - Other States Where Copy of Return is Filed Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Virginia, Washington, West Virginia Form 990, Part VI, Line 19 - Governing Documents Disclosure Explanation These documents are made available upon, request. Form 990, Part IX, Line 24e - Other Expenses. For Paperwork Reduction Act Notice, see the Instructions for Form 890 or SB0EZ. ‘Setiedule O Form 980 oF B0-EZ) BOIS) Privacy Redaction Elbvar werent nama Woodmen Foundation Privacy Redaction L Description Program Service Mgt, & General Fundraising Maint & Repairs Supplies $ 55,847 $ 0 $ 0 Kinston, Service Fees - Te $ 54,212 $ 0 $ ° Natural, Gas $ 49,449 $ 0 $ ° Kinston Service Fees - SS $ 43,479 $ 0 $ ° Bank Card Collection Fees $ 36,806 $ ° $ ° Chemicals & Supplies $ 34,626 $ ° $ 0 Water § Sewer $ 26,580 $ ° $ ° Ground Rent $ 20,000 $ 0 $ 0 Kinston, Service Fees - Gr $ 19,798 $ 0 $ 0 Janitorial Supplies $ 17,515 $ ° $ ° Recreation/Program Suppli $ 16,009 $ 0 $ 0 Real Estate Taxes $ 9,076 $ 9 $ o Saftey & Uniform supplies Page 1 of 3 ‘Schedule 0 (Form 990 or 990-£2) (2016) Woodmen Foundation $ 8,306 Other Expense $ 6,000 Kinston, Camera Fees $ 5,940 Refuse $ 4,537 Representation Fees $ 3,620 Bureau & Association Dues $ 3,287 Telephone Service $ 3,155 Bank Service Charges-Corp $ 0 Kinston, Service Fees - Al $ 3,009 Kinston, Service Fees - Wk $ 3,000 Office Supplies & Materia $ 2,442 Landscaping Supplies $ 2,408 Rent of Other Equipment. $ 2,174 URS Filing Fee $ 0 3,080 1,908 Privacy Redaction Privacy Redaction %. 0. $ 0. $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 § oO § oO $ oO $ oO $. 0 $ 0 Page 2 of 3 ‘Schedule 0 (Form 990 oF 990-£2) (2016) Woodmen Foundation Kinston, Service Fees - 40 $ 1,883 Other Comm Cntr Expenses $ 1,792 Kinston, Service Fees - We $ 1,440 Kinston, Service Fees - OT $ 1,305 Kinston Service Fees - Em $ 1,287 Stormwater $ 1,134 Kinston Service Fees - Tu $ 1,000 CC Cash, Over/Short, $ 880 Kinston, Bank Fees $ 581 Kinston, Service Fees - Lo $ 570 Kinston Repairs & Maint W $ 200 Total $ 443,347 4,988 Privacy Redaction "aloe itetornanba Privacy Redaction $ oO $ 0 $ oO $ oO $ oO $ 0 $ 0 $ 0 $ oO § oO $ oO $. 0 Page 3 of 3 ‘Schedule 0 (Form 990 oF 990-£2) (2016) om 390) . Related Organizations and Unrelated Partnerships | owe ne ssasooer > Complete ite organization answered "Yes" on Form 88, Par Wine 2,24, 386, 38, 7 2016 eee Leta dtetbot Open to Public Soares > Information about Schedule R (Form 990) and its instructions is at www-.irs.goviform9g0, inspection Has oe enon 5 5 Woodmen Foundation paved etecoal Part! __ Identification of Disregarded Entities Complete if the organization answered “Yes” on Form 990, Part IV, line 33. r © @ © @ ane ates and IN ps of degen rnarnnty | Uap i ite rest ame fname Dec cng poo ‘er « @ @ 4) @ Parti! lentification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year. ‘ o @ @ o © Namo sates on EN eae eraiaten Prmaty sity | agp eemileete | Sxange cnt seein | Resectnty ate | obec crag roman) ser eK) ‘si () Woodmen of the World Life Insurance 1700 Farnam Street '47-0339250 Omaha NE 68102 Fraternal NE 501¢8 N/A x @ @ 4) @ For Paperwork Reduction Act Notice, see the Instructions for Form 990, ‘Schedule R (Form 990) 2016 Schodula 8 (Form 990) 2016 Woodmen Foundation 20-47439 Privacy Redaction ro Part ii! [dentification of Related Organizations Taxable as a Partnership Complete If the organization answered "Yes" on Form 990, Part lV, line 34 because it had one or more related organizations treated as a partnership during the tax year. o oe |e, oO © 0 © o a oJ * ane sabes, ot rea aty cwwcteaeting | Pasian, | cravat | sraestensat | cto | caso um fom Pace i eaten bene] say? | ame le * Years” pind arncinton [reg] oe tea. ee doc?) Sedo [pert | ‘ain ‘fom 68) (sre secre S10) hen veal o @ @ @ Part iv [dentification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one of more related organizations treated as a corporation of trust during the tax year. @ © @ @ © o @ o @ ede EN alte erpiaton inary scty | Legalise | iectemnoting | Typecrery| Sweatt shat rerenoge | Sate, ‘since attr” lccop Sewn] meme sector austs ‘mee | SIDE) trig county) see) pia o @ @ @ ‘Schedule R (Form 990) 2016 ‘Schedule R (Form 990) 2016 Woodmen Foundation Privacy Redaction PartV Transactions With Related Organizations Complete if the organization answered “Yes” on Form 990, Part IV, ine 34, 38b, or 36. Note: Compete ne 7 iFany enfiy is sted n Pars Ui Il, orlV of his schedule Yes] No 41 During the tax year, did the organization engage in any ofthe following transactions with one or more related organizations listed in Parts IV? 1 Receipt of (i interest, (i) annuities, (i) royalties, or (iv ent from a controlled entty ta x » Git, grat, or capital contribution to related organization(s) 4b x € Gif, gran, or capital contribution from related organization(s) 4c x 4 Loans or foan guarantees to o for related organization(s) 4 x @ Loans or loan guarantees by related organization(s) te |X Dividends rom related organization(s) 1" x g Sale of assets io related organizations) rm x h Purchase of assets from related organization(s) 48 x | Exchange of assets with related organization(s) 41 x J Lease of facilities, eauipment, or other asses to related organization(s) ux k Lease of facities, equipment, or other assets from related organization(s) 1k x | Performance of services or membership or fundraising solicitations for related organization(s) 1 x 1m Performance of services or membership or fundraising solctations by related organization(s) am] | x 1 Sharing of faites, equipment, mailing lists, or other assets with related organization(s) an x © Sharing of paid employees with related organization(s) 40 a Reimbursement paid to related organization(s) for expenses 4p | x 4 Reimbursement paid by elated organization(s) for expenses, tq| ¥ Other transer of cash or propery to related organization(s) 1" x Other transfer of cash or propery from related organizations) 1s x 2 Ifthe answer to ary ofthe above is “Yes,” 586 te instuctions for information on who must complet this ine, including covered relationships and vansacton thresholds ®) » © @ Nae ted epson Transacion reunites tog tem saatiwaios ‘pe o Woodmen of the World Life Insurance P 40,297| Cash Paid @ Woodmen of the World Life Insurance q 48,900] Cash Paid @ Woodmen of the World Life Insurance e 9,351,939| Amount of Loan “ Woodmen of the Wolrd Life Insurance i 31,524] Cash Paid © cy ‘Schedule R (Form 990) 2016 ‘Schedule R (Form 990) 2016 Woodmen Foundation, 20-47438 Privacy Redaction Part VI Unrelated Organizations Taxable as a Partnership Complete if the organization answered “Yes” on Form 990, Part IV, line 37. Provide the folowing information for each entity taxed as a partnership trough which the organization conducted more than five percent of ts actives (measured by total assets ‘or gross revenue) that was nota related organization. See instructions regarding exclusion for certain investment partnerships. © © @ ny o @ ® o © Name sats and EN ety Prnanacity | Uagd | Prediert [éoapnen| shar sraveot_— Pepoprierat canatler | Portage nie| vare(aaea | sk | ‘moire endotyeor — P'seore? zo | ‘nang | cues (coeur eckeed, SIH019) Co ‘Fem iossy) | tevin | famtourdr|erprtaatire| cary] secrst25%) [Vee] No rYes| No Yes | No. 0 @ @ 4 @ © @ @ @ to - ‘Schedule R (Form 990) 2016 Schedule R (Form 990)2016 Woodmen Foundation Privacy Redaction Page § Part vi Supplemental Information Provide additional information for responses to questions on Schedule R (See instructions). ‘Schedule R (Form 990) 2016

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