| Category / Item | Cost / Other Basis | Accumulated Depreciation | Book Value | End of Year Fair Market Value |
|---|---|---|---|---|
| Auto./Transportation Equip. | 24,918 | 24,918 | 2,883,543 | |
| Furniture and Fixtures | 349,041 | 192,107 | 156,934 | |
| Improvements | 1,348,178 | 658,549 | 689,629 |
| Item No. | 1 |
|---|---|
| Lender's Name | ADIRONDACK BANK |
| Lender's Title | |
| Relationship to Insider | |
| Original Amount of Loan | |
| Balance Due | |
| Date of Note | |
| Maturity Date | |
| Repayment Terms | |
| Interest Rate | |
| Security Provided by Borrower | |
| Purpose of Loan | |
| Description of Lender Consideration | |
| Consideration FMV |
| Description | Beginning of Year - Book Value | End of Year - Book Value | End of Year - Fair Market Value |
|---|---|---|---|
| INVESTMENT IN MUTUAL FUNDS | 12,039 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| ADVERTISING | 4,974 | |||
| AUTO | 791 | |||
| CABLE TV | 7,284 | |||
| DUES AND LICENSES | 4,464 | |||
| FOOD | 114,316 | |||
| HEALTH INSURANCE | 57,226 | |||
| INSURANCE | 50,140 | |||
| MISCELLANEOUS | 1,830 | |||
| OFFICE SUPPLIES | 6,454 | |||
| OUTSIDE SERVICES | 11,412 | |||
| RECREATION & ENTERTAINMENT | 22,473 | |||
| REPAIRS/MAINTENANCE | 33,652 | |||
| TELEPHONE | 10,044 | |||
| TRAINING & EDUCATION | 2,207 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| ENTRANCE FEE | 10,500 | ||
| GROSS RENTS | 1,385,304 | ||
| REIMBURSEMENT INCOME | 11,648 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| 18,726 | 0 | 0 | 0 |
| Name | Address |
|---|---|
| THELMA DOUGLAS |
61 BEEKMAN STREET ROOM 314 PLATTSBURGH,NY12901 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| EXCISE TAX | 47 | |||
| NY STATE | 250 | |||
| PAYROLL | 59,152 | |||
| REAL ESTATE | 105,844 |