| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|
| Name of Stock | End of Year Book Value | End of Year Fair Market Value |
|---|
| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|
| Description | Amount |
|---|---|
| Change in Value | 12,351 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|
| Item No. | 1 |
|---|---|
| Borrower's Name | Louise Bailey |
| Borrower's Title | President |
| Original Amount of Loan | 5000 |
| Balance Due | |
| Date of Note | |
| Maturity Date | |
| Repayment Terms | |
| Interest Rate | |
| Security Provided by Borrower | |
| Purpose of Loan | |
| Description of Lender Consideration | |
| Consideration FMV |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|