| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| LEGAL AND ACCOUNTING | 15,232 | 15,232 | 15,232 |
| Person Name | Explanation |
|---|---|
| BARTON ROBERT | |
| BOWEN JOHNNA | |
| GRINDALL KAY | |
| JONES JUDITH | |
| MALADY KEVIN | |
| MARQUIS DANIELLE | |
| MERRITT VIRGINIA | |
| MICHAUD REGINALD | |
| ROGERS JON | |
| RUSHTON ED | |
| RUSHTON JOYCE | |
| ST PIERRE ROBERT | |
| SEZAK ROBERT | |
| UPHAM RICHARD | |
| YORK LAUREL |
| Description of Property | Date Acquired | Cost or Other Basis | Prior Years' Depreciation | Computation Method | Rate / Life (# of years) |
Current Year's Depreciation Expense | Net Investment Income | Adjusted Net Income | Cost of Goods Sold Not Included |
|---|---|---|---|---|---|---|---|---|---|
| DEPRECIATION | 58,108 |
| Name of Bond | End of Year Book Value | End of Year Fair Market Value |
|---|---|---|
| INVESTMENTS - CORPORATE BONDS | 356,392 | 356,392 |
| Name of Stock | End of Year Book Value | End of Year Fair Market Value |
|---|---|---|
| INVESTMENTS | 1,501,365 | 1,501,365 |
| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| INVESTMENTS - OTHER (MONEY MARKET) | FMV | 108,095 | 108,095 |
| Category / Item | Cost / Other Basis | Accumulated Depreciation | Book Value | End of Year Fair Market Value |
|---|---|---|---|---|
| BUILDING & EQUIPMENT | 1,690,134 | 897,220 | 792,914 | 792,914 |
| LAND | 67,120 | 67,120 | 67,120 |
| Item No. | 1 |
|---|---|
| Lender's Name | PEOPLES HERITAGE BANK |
| Lender's Title | |
| Relationship to Insider | |
| Original Amount of Loan | |
| Balance Due | 568519 |
| Date of Note | |
| Maturity Date | |
| Repayment Terms | |
| Interest Rate | |
| Security Provided by Borrower | |
| Purpose of Loan | |
| Description of Lender Consideration | |
| Consideration FMV |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| EXPENSES | ||||
| WORKERS' COMP INSURANCE - DIR | 8,652 | 8,652 | 8,652 | |
| MEDICAL SUPPLIES | 4,145 | 4,145 | 4,145 | |
| WORKER'S COMP INSURANCE | 1,236 | 1,236 | 1,236 | |
| HOUSEKEEPING SUPPLIES | 3,126 | 3,126 | 3,126 | |
| ACTIVITY SUPPLIES | 5,249 | 5,249 | 5,249 | |
| FOOD | 45,328 | 45,328 | 45,328 | |
| DIETARY SUPPLIES | 3,794 | 3,794 | 3,794 | |
| COOKING GAS | 2,024 | 2,024 | 2,024 | |
| PLANT SUPPLIES | 2,839 | 2,839 | 2,839 | |
| MISC. EXPENSE | 300 | 300 | 300 | |
| DUES AND SUBSCRIPTIONS | 2,051 | 2,051 | 2,051 | |
| INSURANCE - LIABILITY | 8,983 | 8,983 | 8,983 | |
| VEHICLE EXPENSE | 2,504 | 2,504 | 2,504 | |
| OFFICE SUPPLIES | 6,101 | 6,101 | 6,101 | |
| BANK CHARGES | 82 | 82 | 82 | |
| DATA AND PAYROLL PROC. FEES | 5,594 | 5,594 | 5,594 | |
| ADVERTISING - STAFF | 1,613 | 1,613 | 1,613 | |
| OTHER | 1,012 | 1,012 | 1,012 | |
| FEES AND LICENSES | 922 | 922 | 922 | |
| FIRE INSURANCE | 2,098 | 2,098 | 2,098 | |
| WORKERS' COMP INSURANCE | 2,472 | 2,472 | 2,472 | |
| LEASE PAYMENTS | 2,028 | 2,028 | 2,028 | |
| BILLING DIFFERENCES | 716 | 716 | 716 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| ROUTINE SERVICES - STATE | 391,708 | 391,708 | |
| ROUTINE SERVICES - PRIVATE | 464,199 | 464,199 | |
| OTHER INCOME | 1,739 | 1,739 |
| Description | Amount |
|---|---|
| UNREALIZED APPRECIATION ON INVESTMENTS | 144,397 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| DIETARY CONSULTANT | 129 | 129 | 129 | |
| INVESTMENT EXPENSE | 12,608 | 12,608 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| SERVICE PROVIDER TAX | 41,181 | 41,181 | 41,181 | |
| PRIVATE FOUNDATION EXCISE TAX | 480 | 480 | 480 |