| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| LIFE INSURANCE | FMV | 663,374 | 663,374 |
| MUTUAL FUND | FMV | 3,197 | 3,197 |
| MUTUAL FUND | FMV | 209,183 | 209,183 |
| Description | Amount |
|---|---|
| UNREALIZED LOSS ON MUTUAL FUND | 1,810 |
| FEDERAL EXCISE TAX PAID | 103 |
| 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 | 1,223 | 1,223 | 0 | 0 |
| SERVICE FEES | 30 | 30 | 0 | 0 |
| Description | Amount |
|---|---|
| UNREALIZED GAIN ON LIFE INSURANCE CSV | 7,050 |
| Name | Address |
|---|---|
| ROGER P GLORIA J PLOURDE |
14 SEARS ROAD SOUTHBORO,MA01772 |