| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| 1,823 | 456 | 0 | 182 |
| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| NOTE RECEIVABLE - STUDENT DENTAL SERVICE | AT COST | 22,166 | 22,166 |
| Category / Item | Cost / Other Basis | Accumulated Depreciation | Book Value | End of Year Fair Market Value |
|---|---|---|---|---|
| Miscellaneous | 1,614 | 1,614 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| TELEPHONE | 808 | 202 | 81 | |
| STORAGE | 2,934 | |||
| RENT | 1,000 | 250 | 100 | |
| OFFICE EXPENSE | 235 | 23 | ||
| MISCELLANEOUS | 2,000 | 1,850 | ||
| LICENSES & FEES | 20 | 2 | ||
| INSURANCE | 3,816 | 954 | 382 |
| Item No. | 1 |
|---|---|
| Borrower's Name | ETHYLENE WOOD SHANNON |
| Borrower's Title | EXEC DIRECTOR |
| Original Amount of Loan | 3000 |
| Balance Due | 3000 |
| Date of Note | 2011-01 |
| Maturity Date | 2012-07 |
| Repayment Terms | BALLOON PAYMENT |
| Interest Rate | |
| Security Provided by Borrower | NONE |
| Purpose of Loan | |
| Description of Lender Consideration | |
| Consideration FMV |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| CA FRANCHISE TAX BOARD | 35 |