| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| ACCOUNTING | 5,525 | 5,525 |
| Description of Amortized Expenses | Date Acquired, Completed, or Expended | Amount Amortized | Deduction for Prior Years | Amortization Method | Current Year Amortization | Net Investment Income | Adjusted Net Income | Total Amount of Amortization |
|---|---|---|---|---|---|---|---|---|
| AMORTIZATION - ORGANIZATION | 3,951 | 3,951 | 3,951 |
| Person Name | Explanation |
|---|---|
| KATHLEEN HARRIS | |
| PETER FARNSWORTH | |
| SHAWN HARRIS | |
| LYNN HALL | |
| ZAN HARRIS | |
| LITA BLANCHARD | |
| SHARON FARNSWORTH | |
| CLINTON PHILLIPS | |
| KATHERINE PHILLIPS |
| 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 - BLDG & IMPROVE | 72,019 | 72,019 | |||||||
| DEPRECIATION - LAND IMPROVEMEN | 5,351 | 5,351 | |||||||
| DEPRECIATION 10 YR EQUIPMENT | 9,852 | 9,852 | |||||||
| DEPRECIATION - EQUIPMENT | 86 | 86 | |||||||
| DEPRECIATION MOTOR VEHICLES | 6,474 | 6,474 | |||||||
| DEPRECIATION MOTOR VEHICLE | 743 | 743 | |||||||
| DEPRECIATION LEASEHOLD IMPROV | 23,174 | 23,174 | |||||||
| DEPRECIATION LEASEHOLD IMP | 200 | 200 |
| Name | Date Acquired | How Acquired | Date Sold | Purchaser Name | Gross Sales Price | Basis | Basis Method | Sales Expenses | Total (net) | Accumulated Depreciation |
|---|---|---|---|---|---|---|---|---|---|---|
| SALE OF BUS | 2002-04 | PURCHASE | 2012-01 | 1,000 | 56,334 | -926 | 54,408 |
| Category / Item | Cost / Other Basis | Accumulated Depreciation | Book Value | End of Year Fair Market Value |
|---|---|---|---|---|
| BUILDING & IMPROVEMENT | 1,720,346 | 72,019 | 1,648,327 | 1,648,327 |
| LEASEHOLD IMPROVEMENTS | 332,041 | 74,768 | 257,273 | 257,273 |
| EQUIPMENT MAJOR MOVEABLE | 123,685 | 74,088 | 49,597 | 49,597 |
| EQUIPMENT MOTOR VEHICLES | 98,655 | 56,489 | 42,166 | 42,166 |
| LAND IMPROVEMENTS | 52,114 | 5,351 | 46,763 | 46,763 |
| COMPUTER EQUIPMENT | 10,596 | 9,662 | 934 | 934 |
| LEASEHOLD IMPROVEMENTS | 3,172 | 798 | 2,374 | 2,374 |
| EQUIP. MAJOR MOVEABLE 10 Y | 2,137 | 93 | 2,044 | 2,044 |
| LAND | 105,992 | 105,992 | 105,992 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| ADMIN - LEGAL FEES | 1,373 | 1,373 |
| Item No. | 1 |
|---|---|
| Lender's Name | ANDROSCOGGIN BANK |
| Lender's Title | |
| Relationship to Insider | |
| Original Amount of Loan | 14450 |
| Balance Due | 12702 |
| Date of Note | 2012-11 |
| Maturity Date | 2017-11 |
| Repayment Terms | MONTHLY P&I |
| Interest Rate | 0.0500 |
| Security Provided by Borrower | VEHICLE |
| Purpose of Loan | PURCHASE VEHICLE |
| Description of Lender Consideration | |
| Consideration FMV |
| Item No. | 2 |
|---|---|
| Lender's Name | ANDROSCOGGIN BANK |
| Lender's Title | |
| Relationship to Insider | |
| Original Amount of Loan | 24000 |
| Balance Due | 20364 |
| Date of Note | 2012-09 |
| Maturity Date | 2017-10 |
| Repayment Terms | MONTHLY P&I |
| Interest Rate | 0.0500 |
| Security Provided by Borrower | VEHICLE |
| Purpose of Loan | PURCHASE VEHICLE |
| Description of Lender Consideration | |
| Consideration FMV |
| Description | Beginning of Year - Book Value | End of Year - Book Value | End of Year - Fair Market Value |
|---|---|---|---|
| ORGANIZATION COSTS AND INTANGIBLES | 37,555 | 37,555 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| EXPENSES | ||||
| ADMIN - DATA PROCESSING FEES | 40,000 | 40,000 | ||
| PAYROLL SERVICE FEES | 4,566 | 4,566 | ||
| HOUSEKEEPING | 1,701 | 1,701 | ||
| EMPLOYEE RECRUITMENT AND RETE | 4,343 | 4,343 | ||
| DUES AND SUBSCRIPTIONS | 2,744 | 2,744 | ||
| INSURANCE | 58,268 | 58,268 | ||
| BANK AND LATE FEES | 1,548 | 1,548 | ||
| NURSING AND PHARMACY | 6,590 | 6,590 | ||
| MARKETING AND PROMOTIONS | 3,636 | 3,636 | ||
| ACTIVITIES PROGRAM | 8,079 | 8,079 | ||
| OFFICE EXPENSE | 23,458 | 23,458 | ||
| FOOD AND DIETARY SUPPLIES | 28,647 | 28,647 | ||
| MEDICAL AND OPERATING SUPPLIE | 139,711 | 139,711 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| DAY HAB PROGRAM | 256,621 | 256,621 | |
| ICF/MR REVENUE | 2,972,015 | 2,972,015 | |
| MISCELLANEOUS REVENUE | 3,175 | 3,175 |
| Description | Amount |
|---|---|
| NET ASSETS RECEIVED FROM BEAM INC | 209,260 |
| Description | Beginning of Year - Book Value | End of Year - Book Value |
|---|---|---|
| DUE TO/FROM NCA | 51,213 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| MANAGEMENT FEE EXPENSE | 100,000 | 100,000 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| PROVIDER AND OTHER TAXES | 192,292 | 192,292 |