| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| LIFE INSURANCE | FMV | 624,829 | 624,829 |
| MUTUAL FUND | FMV | 2,861 | 2,861 |
| MUTUAL FUND | FMV | 139,891 | 139,891 |
| Description | Amount |
|---|---|
| UNREALIZED LOSS ON MUTUAL FUND | 27,064 |
| UNREALIZED LOSS ON LIFE INSURANCE CSV | 21,606 |
| FEDERAL EXCISE TAX PAID | 34 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| MANAGEMENT FEES | 912 | 912 | 0 | 0 |
| STATE FILING FEES | 35 | 0 | 0 | 0 |
| SERVICE FEES | 30 | 30 | 0 | 0 |
| Name | Address |
|---|---|
| GLORIA J PLOURDE |
14 SEARS ROAD SOUTHBORO,MA01772 |