| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| LIFE INSURANCE | FMV | 645,289 | 645,289 |
| MUTUAL FUND | FMV | 3,138 | 3,138 |
| MUTUAL FUND | FMV | 247,613 | 247,613 |
| Description | Amount |
|---|---|
| FEDERAL EXCISE TAX PAID | 175 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| STATE FILING FEES | 35 | 0 | 0 | 0 |
| MANAGEMENT FEES | 1,488 | 1,488 | 0 | 0 |
| SERVICE FEES | 150 | 150 | 0 | 0 |
| Description | Amount |
|---|---|
| UNREALIZED GAIN ON MUTUAL FUND | 14,513 |
| UNREALIZED GAIN ON LIFE INSURANCE CSV | 9,820 |
| Name | Address |
|---|---|
| ROGER P GLORIA J PLOURDE |
14 SEARS ROAD SOUTHBORO,MA01772 |