| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Accounting fees | 2,600 | 0 | 2,600 | 0 |
| Description | Beginning of Year - Book Value | End of Year - Book Value | End of Year - Fair Market Value |
|---|---|---|---|
| CASH VALUE LIFE INSURANCE | 167,543 | 172,421 | 183,026 |
| Description | Amount |
|---|---|
| LIFE INSURANCE EXPENSE | 20,577 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Filing fees | 75 | 75 |
| Name | Address |
|---|---|
| SEE SCHEDULE B |
|