| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| ACCOUNTING | 11,150 | 0 | 11,150 |
| 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 |
|---|---|---|---|---|---|---|---|---|---|
| EQUIPMENT | 2007-01-01 | 35,313 | 35,313 | SL | 5.000000000000 | 0 | 0 | ||
| EQUIPMENT | 2008-01-01 | 70,316 | 70,316 | SL | 5.000000000000 | 0 | 0 | ||
| EQUIPMENT - WHITE BOARD | 2011-03-25 | 2,138 | 2,068 | SL | 5.000000000000 | 0 | 0 | ||
| COMPUTER EQUIPMENT | 2012-10-15 | 1,729 | 1,729 | SL | 5.000000000000 | 0 | 0 | ||
| COMPUTER EQUIPMENT | 2012-11-15 | 3,484 | 3,484 | SL | 5.000000000000 | 0 | 0 | ||
| PHONE SYSTEM | 2013-08-15 | 5,617 | 4,960 | SL | 5.000000000000 | 657 | 0 | ||
| PHONE SYSTEM | 2013-11-27 | 1,872 | 1,527 | SL | 5.000000000000 | 345 | 0 | ||
| RUG | 2013-01-15 | 11,282 | 8,060 | SL | 7.000000000000 | 1,612 | 0 | ||
| TELEVISION | 2013-01-15 | 2,298 | 2,298 | SL | 5.000000000000 | 0 | 0 | ||
| OFFICE FURNITURE | 2013-01-22 | 1,651 | 1,160 | SL | 7.000000000000 | 236 | 0 | ||
| TELEVISION | 2013-08-15 | 3,247 | 2,867 | SL | 5.000000000000 | 380 | 0 | ||
| OFFICE FURNITURE | 2013-09-15 | 1,590 | 984 | SL | 7.000000000000 | 227 | 0 | ||
| OFFICE FURNITURE | 2013-12-15 | 1,590 | 927 | SL | 7.000000000000 | 227 | 0 | ||
| COMPUTER EQUIPMENT | 2014-02-15 | 1,039 | 814 | SL | 5.000000000000 | 208 | 0 | ||
| EQUIPMENT | 2014-05-15 | 1,943 | 1,426 | SL | 5.000000000000 | 389 | 0 | ||
| OFFICE CHAIRS | 2015-11-15 | 12,774 | 3,954 | SL | 7.000000000000 | 1,825 | 0 | ||
| EQUIPMENT | 2015-05-27 | 9,843 | 5,086 | SL | 5.000000000000 | 1,969 | 0 | ||
| CABINET HARDWARE | 2015-09-24 | 5,887 | 2,648 | SL | 5.000000000000 | 1,177 | 0 | ||
| TELEVISION | 2015-12-15 | 4,998 | 2,083 | SL | 5.000000000000 | 1,000 | 0 |
| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990PF, PART VII-B, LINE 3A: | AMERICAN WELL:THE FOUNDATION OWNS GREATER THAN 2% OF AMERICAN WELL, A PRIVATE COMPANY, HOWEVER COLLECTIVELY ALL DISQUALIFIED PERSONS AND THE FOUNDATION OWN LESS THAN 20%. |
| Name of Stock | End of Year Book Value | End of Year Fair Market Value |
|---|---|---|
| INVESTMENTS | 2,082,456 | 350,420 |
| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| CCF PARTNERS II, LLC | AT COST | 20,301,871 | 27,464,486 |
| Category / Item | Cost / Other Basis | Accumulated Depreciation | Book Value | End of Year Fair Market Value |
|---|---|---|---|---|
| EQUIPMENT | 35,313 | 35,313 | 0 | |
| EQUIPMENT | 70,316 | 70,316 | 0 | |
| EQUIPMENT - WHITE BOARD | 2,138 | 2,068 | 70 | |
| COMPUTER EQUIPMENT | 1,729 | 1,729 | 0 | |
| COMPUTER EQUIPMENT | 3,484 | 3,484 | 0 | |
| PHONE SYSTEM | 5,617 | 5,617 | 0 | |
| PHONE SYSTEM | 1,872 | 1,872 | 0 | |
| RUG | 11,282 | 9,672 | 1,610 | |
| TELEVISION | 2,298 | 2,298 | 0 | |
| OFFICE FURNITURE | 1,651 | 1,396 | 255 | |
| TELEVISION | 3,247 | 3,247 | 0 | |
| OFFICE FURNITURE | 1,590 | 1,211 | 379 | |
| OFFICE FURNITURE | 1,590 | 1,154 | 436 | |
| COMPUTER EQUIPMENT | 1,039 | 1,022 | 17 | |
| EQUIPMENT | 1,943 | 1,815 | 128 | |
| OFFICE CHAIRS | 12,774 | 5,779 | 6,995 | |
| EQUIPMENT | 9,843 | 7,055 | 2,788 | |
| CABINET HARDWARE | 5,887 | 3,825 | 2,062 | |
| TELEVISION | 4,998 | 3,083 | 1,915 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| LEGAL | 162,315 | 0 | 162,315 |
| Description | Beginning of Year - Book Value | End of Year - Book Value | End of Year - Fair Market Value |
|---|---|---|---|
| ARTWORK | 435,487 | 435,487 | 435,487 |
| DUE FROM AFFILIATES | 0 | 832 | 832 |
| FEDERAL TAX PREPAID | 0 | 10,000 | 10,000 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| INVESTMENT ADVISORY FEES | 495,000 | 495,000 | 0 | |
| INSURANCE | 42,938 | 0 | 42,938 | |
| MEALS & ENTERTAINMENT | 714 | 0 | 714 | |
| OFFICE EXPENSE | 13,760 | 0 | 13,760 | |
| FROM PASS-THROUGH CCF PARTNERS II - NET LOSS | 442,213 | 128,110 | 0 | |
| PAYROLL FEES | 2,200 | 0 | 2,200 | |
| DATA CONNECTIVITY | 6,059 | 0 | 6,059 | |
| MAINTENANCE | 9,731 | 0 | 9,731 | |
| TELEPHONE EXPENSE | 1,051 | 0 | 1,051 | |
| OFFICE EQUIPMENT EXPENSE | 2,126 | 0 | 2,126 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| FROM PASS-THROUGH CCF II PARTNERS, LLC - RENTAL INCOME | 18,159 | 18,159 | 18,159 |
| Description | Amount |
|---|---|
| UNREALIZED INVESTMENT GAIN | 520,391 |
| NON-TAXABLE GAIN ON QR TOWER 605 LLC PROPERTY GRANT | 98,682 |
| Description | Beginning of Year - Book Value | End of Year - Book Value |
|---|---|---|
| DUE TO AFFILIATES | 3,970 | 0 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| CONSULTING | 112,480 | 0 | 112,480 | |
| MANAGEMENT FEES | 423 | 0 | 423 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| PAYROLL TAXES | 15,968 | 0 | 15,968 |