A 4l,b2r ip du anld assessments 3 2, 789. n stment Income)! SEE SCHEDULE

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1 00 ^ ru z M Short Form Return of Organization Exempt From Inome Tax Under setion 501(), 527, or 4947( a)(1) of the Internal Revenue Code (exept blak lung benefit trust or Form 990^EZ private foundation) Sponsoring organizations of donor advised funds, ganizations that operate one or more hospital failities, and ertain ontrolling Department of the Treasury I organizations as defined in setion 512(bX13) must file Form 990 All other organizations with gryoss reeipts less than $200,000 and total Internal Revenue Servie The organization ma y nave to useaogo0 a'or eths Iretur71 tosates tsa `m A For the 2010 alendar year, or tax year beginning and B Ch appliab le Address hange C Name of organization ONamehange JACKSONVILLE FOP LODGE 125 Initial return Number and street (or P.O. box, if mail is not delivered to street address) Terminated 200 W DOUGLAS =Amended return I City or town, state or ountry, and ZIP + 4 G Aounting Method: L Cash U Arual Other (speify) I Website: N/A L1 I /'f 17-&A Q.7lJ F Group Exemption Number 1199 H Chek Mf the organization is not required to attah Shedule B J Tax- exempt status (hek only one) - U 501()(3)LXJ 501() ( 8 )' (Insert no.) U 4947(a)(1) or U 5271 (Form 990, 990-EZ, or 990-PF). K Chek if the organization is not a setion 509(a)(3) supporting organization and its gross reeipts are normally not more than $50,000. A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postard) may be required (see instrutions). But if the organization hooses to file a return, be sure to file a omplete return. L Add lines 5b, 6, and 7b, to line 9 to determine gross reeipts. If gross reeipts are $200,000 or more, or if total assets (Part II, line 25, olumn ( B ) below ) are $500, 000 or more, file Form 990 instead of Form 990-EZ 19, 993. Part I Revenue, Expenses, and Changes in Net Assets or Fund Balanes (see the instrutions for Part l.) nh eok4tpe-ea an+zatlon used Shedule 0 to res p ond to any q uestion in this Part I R 1 SVEO gifts,, N m CL ^x ^W rants, and similar amounts reeived rogram servie ravelnue inluding government fees and ontrats 2 A 4l,b2r ip du anld assessments 3 2, 789. n stment Inome)! SEE SCHEDULE Aa_.Gu ss oun tro'm'sale of assets other than inventory 5a b ;L-mejS!0os' o other basls and sales expenses 5b ln r oss fromsale of assets other than inventory ( Subtrat line 5b from line 5a) 6 Gaming and fundraising events a Gross inome from gaming ( attah Shedule G if greater than $15,000) 6a b Gross inome from fundraising events ( not inluding $ of ontributions from fundraising events reported on line 1) (attah Shedule G if the sum of suh gross inome and ontributions exeeds $15,000) Less: diret expenses from gaming and fundraising events 6 d Net inome or (loss ) from gaming and fundraising events ( add lines 6a and 6b and subtrat line 6) 7a Gross sales of inventory, less returns and allowanes 7a b Less: ost of goods sold 7b Gross profit or (loss ) from sales of inventory ( Subtrat line 7b from line 7a) 8 Other revenue (desribe in Shedule 0) SEE SCHEDULE 0 9 Total revenue. Add lines 1, 2, 3, 4, 5, 6d, 7, and 8 10 Grants and similar amounts paid (list in Shedule 0) SEE SCHEDULE 0 11 Benefits paid to or for members 12 Salaries, other ompensation, and employee benefits 13 Professional fees and other payments to independent ontrators 14 Oupany, rent, utilities, and maintenane 15 Printing, publiations, postage, and shipping 16 Other expenses (desribe in Shedule 0) SEE SCHEDULE 0 17 Total expenses Add lines 10 through 16 U) 18 Exess or (defiit) for the year (Subtrat line 17 from line 9) y 19 Net assets or fund balanes at beginning of year (from line 27, olumn (A)), (must agree with end-of-year figure reported on prior year's return) Z 20 Other hanges in net assets or fund balanes (explain in Shedule 0) SEE SCHEDULE 0 21 Net assets or fund balanes at end of year. Combine lines 18 throw h 20 LHA For Paperwork Redution At Notie, see the separate instrutions. 6b OMB No oen to Publi D Employer identifiation number J1-v7'37a Room/suite E Telephone number , , , Form 990-EZ (2010)

2 Form990-EZ 2010 JACKSONVILLE FOP LODGE Page2 Part 11 Balane Sheets. ( see the instrutions for Part II.) Chek if the oraanization used Shedule 0 to respond to any question in this Part II (A) Beginning of year ( B) End of year 22 Cash, savings, and investments 41, , Land and buildings Other assets ( desribe in Shedule 0) Total assets 1, , Total liabilities ( desribe in Shedule 0) Net assets or fund balanes ( line 27 of olumn ( B ) must a g ree with line 21 ) , 217. Part III Statement of Program Servie Aomplishments ( see the instrutions for Part ill.) Expenses Chek it the organization used Shedule 0 to res p ond to an y q uestion in this Part Ill What is the organization ' s primary exempt purpose? SEE SCHEDULE 0 Desribe what was ahieved in arrying out the organization's exempt purposes. In a lear and onise manner, desnbe the servies provided, the number of persons benefited, and other relevant information for eah program title. 28 FRATERNAL ACTIVITIES OF LAW ENFORCEMENT OFFICERS. (Required for setion 5 01 ()( 3 ) and 501 ()( 4 ) organizations and setion 4947 ( a)(1) trusts; optional for others.) 29 (Grants $ If this amount inludes foreig n grants, hek here a 30 (Grants $ If this amount inludes forei g n g rants, hek here 01 Ej 29a (Grants $ If this amount inludes forei g n g rants, hek here 0 30a 31 Other program servies (desribe in Shedule 0) (Grants $ If this amount inludes foreig n g rants, hek here 31a 32 Total program servie ex penses (add lines 28a throug h 31 a ) 32 Part IV List of Offiers, Diretors, Trustees, and Key Employees. List eah one even if not ompensated (see the instrutions for Part IV) Chek if the oraanlzatlon used Shedule 0 to resoond to any question in this Part IV M () Compensation ( d) Contributions (a) Name and address (b) Title and average hours per week devoted to position (If not paid, enter - 0-) to em ployee be nefit plans & deferred omoensation ( e) Expense aount and other allowanes JERRY LIEB RESIDENT 200 W DOUGLAS, JACKSONVILLE, IL EDWARD BROADDUS ICE-PRESIDE 200 W DOUGLAS, JACKSONVILLE, IL GREG LOWDER SECRETARY 200 W DOUGLAS, JACKSONVILLE, IL RODNEY COX TREASURER 200 W DOUGLAS, JACKSONVILLE, IL Form 990-EZ (2010

3 Form 990-EZ (2010) JACKSONVILLE FOP LODGE Page 3 Part V Other Information (Note the statement requirements in the instrutions for Part V) Chek if the or g anization used Shedule 0 to res p ond to any q uestion in this Part V I-XI Yes No 33 Did the organization engage in any ativity not previously reported to the IRS? If 'Yes,' provide a detailed desription of eah ativity in Shedule 0 33 X 34 Were any signifiant hanges made to the organizing or governing douments? If 'Yes,* attah a onformed opy of the amended douments if they reflet a hange to the organization's name. Otherwise, explain the hange on Shedule 0 (see instrutions) 34 X 35 If the organization had inome from business ativities, suh as those reported on lines 2, 6a, and 7a (among others), but not reported on Form 990-T, explain in Shedule 0 why the organization did not report the inome on Form 990-T. a Did the organization have unrelated business gross inome of $1,000 or more or was it a setion 501()(4), 501()(5), or 501()(6) organization subjet to setion 6033(e) notie, reporting, and proxy tax requirements? 35a X b If 'Yes, has it filed a tax return on Form 990 -T for this years 35b N 36 Did the organization undergo a liquidation, dissolution, termination, or signifiant disposition of net assets during the year? If 'Yes,' omplete appliable parts of Shedule N 36 X 37a Enter amount of politial expenditures, diret or indiret, as desribed in the instrutions. 37a 0. b Did the organization file Form POL for this year? 37b X 38a Did the organization borrow from, or make any loans to, any offier, diretor, trustee, or key employee or were any suh loans made in a prior year and still outstanding at the end of the tax year overed by this return? 38a X b If 'Yes, omplete Shedule L, Part II and enter the total amount involved 38b N / A 39 Setion 501()(7) organizations. Enter: a Initiation fees and apital ontributions inluded on line 9 39a N / A b Gross reeipts, inluded on line 9, for publi use of lub failities 39b N / A 40a Setion 501()(3) organizations. Enter amount of tax imposed on the organization during the year under: setion 4911 N/A ; setion 4912 N/A ; setion 4955 N/A b Setion 501()(3) and 501()(4) organizations. Did the organization engage in any setion 4958 exess benefit transation during the year, or did it engage in an exess benefit transation in a prior year, that has not been reported on any of its prior Forms 990 or 990-EZ? If "Yes, omplete Shedule L, Part 40b N Setion 501()(3) and 501()(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under setions 4912, 4955, and 4958 N/A d Setion 501()(3) and 501()(4) organizations. Enter amount of tax on line 40 reimbursed by the organization N/A e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transation? If 'Yes,' omplete Form e X 41 List the states with whih a opy of this return is filed. IL 42a The organization's books are in are of RODNEY COX Telephone no. loo- 217 / Loated at W DOUGLAS AVE, JACKSONVILLE, IL ZIP b At any time during the alendar year, did the organization have an interest in or a signature or other authority over a finanial aount in a foreign ountry (suh as a bank aount, seurities aount, or other finanial Yes No aount)? 42b X If 'Yes,' enter the name of the foreign ountry: See the instrutions for exeptions and filing requirements for Form TD F , Report of Foreign Bank and Finanial Aounts. At any time during the alendar year, did the organization maintain an offie outside of the U.S.' 42 X If 'Yes, enter the name of the foreign ountry: 43 Setion 4947(a)(1) nonexempt haritable trusts filing Form 990-EZ in lieu of Form Chek here 71 and enter the amount of tax-exempt interest reeived or arued during the tax year 143 I N/A 44a Did the organization maintain any donor advised funds during the year? If 'Yes; Form 990 must be ompleted instead of Form 990-EZ b Did the organization operate one or more hospital failities during the year? If 'Yes,' Form 990 must be ompleted instead of Form 990-EZ Did the organization reeive any payments for indoor tanning servies during the year? d If 'Yes' to line 44, has the organization filed a Form 720 to report these payments? If "No," provide an explanation No Form 990-EZ (2010)

4 Form 990-EZ ( Page4 Yes No 45 Is any related organization a ontrolled entity of the organization within the meaning of setion 512(b)(13)? a Did the organization reeive any payment from or engage in any transation with a ontrolled entity within the meaning of setion 512(b)(13)? If 'Yes, Form 990 and Shedule R may need to be ompleted instead of Form 990-EZ 46 Did the organization engage, diretly or indiretly, in politial ampaign ativities on behalf of or in opposition to andidates for publi offie? If "Yes,' omplete S hedule C, Part I NIart Vl I Setion 501 ()(3) organizations and setion 4947(a)(1) nonexempt haritable trusts only. All setion 501()(3) organizations and setion 4947(a)(1) nonexempt haritable trusts must answer questions 47-49b and 52, and omplete the tables for lines 50 and 51. Chek if the oraamzatlon used Shedule 0 to respond to any question in this Part VI 47 Did the organization engage in lobbying atlvities7 If "Yes," omplete Shedule C, Part II Is the organization a shool as desribed in setion 170 (b)(1)(a)(n)? If "Yes," omplete Shedule E 48 49a Did the organization make any transfers to an exempt non-haritable related organization? 49a b If 'Yes; was the related organization a setion 527 organization? 49b 50 Complete this table for the organization's five highest ompensated employees ( other than offiers, diretors, trustees and key employees ) who eah reeived more than $100,000 of om pensation from the or ganization. If there is none, enter 'N one' (a) Name and address of eah employee paid more than $100,000 N /A (b) Title and average hours per week devoted to position () Compensation (d) Contributions to mployee benefit plans& deferred ompensation No (e) Expense aountand other allowanes f Total number of other employees paid over $100, Complete this table for the organization's five highest ompensated independent ontrators who eah reeived more than $100,000 of ompensation from the org anization. If there is none, enter 'None.' N / A (a) Name and address of eah Independent ontrator paid more than $100,000 (b) Type of servie () Compensati on d Total number of other independent ontrators eah reeiving over $100, Did the organization omplete Shedule A? Note : All setion 501()(3) organs haritable trusts must attah a ompleted Shedule 9--N Sign Here IF Signature of offier ^+ajn^ ^-. ez Type or print name and title Print/Type preparer's name Paid Preparer JASON D. JONES Use Only Firm's name KERBER ECK Firm's address 1000 MYERS SPRINGFIELD May the IRS disuss this return with the preparer shown abov signature 1 0 ^ ILDING IL 62701

5 SCHEDULE G (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Servie Name ofthe organization Part I Supplemental Information Regarding Fundraising or Gaming Ativities OMB No Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, Open To Publi or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Attah to Form 990 or Form 990-EZ. See separate instrutions. Inspetion Employer identifiation number 12 Fundraising Ativities. Complete If the organization answered "Yes" to Form 990, Part IV, line 17 Form 990-EZ filers are not required to omplete this part 1 Indiate whether the organization raised funds through any of the following ativities. Chek all that apply. a O Mail soliitations e Soliitation of non -government grants b O Internet and soliitations f 0 Soliitation of government grants 0 Phone soliitations g 0 Speial fundraising events d In-person soliitations 2 a Did the organization have a written or oral agreement with any individual (inluding offiers, diretors, trustees or key employees listed in Form 990, Part VII) or entity in onnetion with professional fundraising servies? El Yes 0 No b If "Yes," list the ten highest paid individuals or entities (fundraisers ) pursuant to agreements under whih the fundraiser is to be ompensated at least $5,000 by the organization. (i) Name and address of individual or entity (fundraiser) (ii) Ativity (iii) Did rundre^ser horvontroiof ontributions? (iv) Gross reeipts from ativity (v) Amount paid to (or retained by) fundraiser listed in ol (i) (vi) Amount paid to (or retained by) organization Yes No Total 3 List all states in whih the organization is registered or liensed to soliit ontributions or has been notified it is exempt from registration or liensing LHA Paperwork Redution At Notie, see the Instrutions for Form 990 or 990-EZ. Shedule G (Form 990 or EZ)

6 Shedule G ( Form 990 or JACKSONVILLE FOP LODGE Page 2 Part II Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event ontributions and gross inome on Form 990-EZ, lines 1 and 6b. List events with gross reeipts greater than $5,000. C (a) Event #1 (b) Event #2 () Other events (d) Total events NONE GOLF OUTING (add ol (a) through ol. () (event type) (event type) (total number) ) 1 Gross reeipts 16, , Less- Charitable ontributions 3 Gross inome line 1 minus line 2 ) 16, , Cash prizes Nonash prizes 6 Rent/faility osts 5, , Food and beverages 1, , Entertainment 9 Other diret expenses 1, , Diret expense summary. Add lines 4 through 9 in olumn (d) Net inome summary. Combine line 3, olumn (d ), and line 10 7, 932. Part III Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than a) a^ T r 1 $15,000 on Form 990-EZ, line 6a. (a) Bingo (b) Pull tabs/instant bingo/progressive bingo () Other gaming (d) Total gaming (add of (a) through ol ()),, 1 2 Cash prizes a> 3 Nonash prizes O 4 Rent/faility osts Other diret 6 Volunteer labor Yes % L-I Yes % " Yes % No EINo 7 Diret expense summary. Add lines 2 through 5 in olumn (d) olumn d. and line 9 Enter the state (s) in whih the organization operates gaming ativities* a Is the organization liensed to operate gaming ativities in eah of these states? Yes = No b If "No," explain. 10a Were any of the organization ' s gaming lienses revoked, suspended or terminated during the tax year? Yes 0 No b If "Yes," explain Shedule G (Form 990 or 990-EZ) 2010

7 Shedule G ( Form 990 or 990 EZ) 2010 JACKSONVILLE FOP LODGE Page 3 11 Does the organization operate gaming ativities with nonmembers? Yes 0 No 12 Is the organization a grantor, benefiiary or trustee of a trust or a member of a partnership or other entity formed to administer haritable gaming? _ Yes 0 No 13 Indiate the perentage of gaming ativity operated in: a The organization ' s faility 13a % b An outside faility 13b % 14 Enter the name and address of the person who prepares the organization ' s gaming /speial events books and reords Name Address 15a Does the organization have a ontrat with a third party from whom the organization reeives gaming revenue? = Yes El No b If "Yes," enter the amount of gaming revenue reeived by the organization $ and the amount of gaming revenue retained by the third party $ If "Yes," enter name and address of the third party: Name Address 16 Gaming manager information Name Gaming manager ompensation $ Desription of servies provided _ 0 Diretor/offier El Employee 0 Independent ontrator 17 Mandatory distributionsa Is the organization required under state law to make haritable distributions from the gaming proeeds to retain the state gaming liense? 0 Yes El No b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization's own exem p t ativities durin g the tax year $ Part IV Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, olumns (n) and (v), and Part III, lines 9, 9b, 10b, 15b, 15, 16, and 17b, as appliable. Also omplete this part to provide any additional information (see instrutions) Shedule G (Form 990 or EZ) 2010

8 SCHEDULE 0 (Form 990 or 990-EZ) Department of the Treasury Name of the organization Supplemental Information to Form 990 or 990-EZ " ""tl NO ""'-VU., Complete to provide information for responses to speifi questions on 2010 Form 990 or 990-EZ or to provide any additional information. Open to Publi Attah to Form 990 or 990-EZ. Inspetion Employer identifiation number FORM 990-EZ, PART I, LINE 4, OTHER INVESTMENT INCOME: DESCRIPTION OF PROPERTY: AMOUNT: DIVIDENDS 247. FORM 990-EZ, PART I, LINE 8, OTHER REVENUE: DESCRIPTION OF OTHER REVENUE: AMOUNT: INTEREST 30. OTHER 130. TOTAL TO FORM 990-EZ, LINE FORM EZ, PART I, LINE 10, GRANTS AND ALLOCATIONS: ACTIVITY CLASSIFICATION: CONTRIBUTIONS AND SPONSORSHIPS GRANTEE NAME : VARIOUS AMOUNT GIVEN: 3,284. FORM 990-EZ, PART I, LINE 16, OTHER EXPENSES: DESCRIPTION OF OTHER EXPENSES: AMOUNT: MISCELLANEOUS 403. MEETINGS/CONFERENCES 1,463. TOTAL TO FORM 990-EZ, LINE 16 1,866. FORM 990-EZ, PART I, LINE 21, CHANGES IN NET ASSETS: CHANGES IN NET ASSETS OR FUND BALANCES: AMOUNT: UNREALIZED GAIN ON INVESTMENTS 1,130. LHA For Paperwork Redution At Notie, see the Instrutions for Form 990 or 990-EZ. Shedule 0 (Form 990 or 990-EZ) (2010)

9 SCHEDULE 0 (Form 990 or 990-EZ) Department of the Treasury Name of the organization Supplemental Information to Form 990 or 990-EZ Complete to provide information for responses to speifi questions on Form 990 or 990-EZ or to provide any additional information. 00- Attah to Form 990 or 990-EZ. OMB No Open to Publi Inspetion Employer identifiation number 7 A 'Onn TrtTV t 1 7C. A1 -nqa0qq1zz FORM 990-EZ, PART III, PRIMARY EXEMPT PURPOSE - RECREATION AND SCHOLARSHIPS FOR YOUTH AND OTHER COMMUNITY SERVICES. FORM 990-EZ, PART V, INFORMATION REGARDING PERSONAL BENEFIT CONTRACTS: THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY, OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT. THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY, OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT. LHA For Paperwork Redution At Notie, see the Instrutions for Form 990 or EZ. Shedule 0 (Form 990 or EZ) (2010)