| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| INDIRECT ACCOUNTING FEES | 126 |
| 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 |
|---|---|---|---|---|---|---|---|---|---|
| DEHUMIDIFIER | 2013-01-03 | 240 | 240 | 200DB | 5.0000 | ||||
| HP PROBOOK 4540 LAPTOP | 2014-01-02 | 680 | 680 | 200DB | 5.0000 | ||||
| HP PROBOOK 4540 LAPTOP | 2014-01-02 | 680 | 680 | 200DB | 5.0000 | ||||
| LAND | 2007-12-12 | 10,000 | |||||||
| SHOWER, TOILET, FLOOR REMODEL | 2013-08-23 | 4,425 | 2,085 | S/L | 15.0000 | 156 | |||
| GIBSON HEATING/COOLING SYSTEM | 2013-07-01 | 8,719 | 8,719 | 200DB | 5.0000 | ||||
| 636 SR 29 OFFICE BLD | 2007-12-12 | 100,000 | 49,242 | S/L | 27.5000 | 3,636 | |||
| 2014 DODGE CARAVAN | 2015-06-10 | 21,034 | 21,034 | 200DB | 5.0000 | ||||
| OUTDOOR SIGN | 2015-07-27 | 548 | 511 | 200DB | 7.0000 | 24 | |||
| SMALL COUCH & 3 RECLINERS | 2015-07-28 | 52 | 48 | 200DB | 7.0000 | 2 | |||
| PRINTER | 2017-01-31 | 4,562 | 4,053 | 200DB | 7.0000 | 204 | |||
| VIZIO 43" HDTV | 2018-05-24 | 124 | 80 | 200DB | 7.0000 | 13 | |||
| WHEELCHAIR RAMP | 2019-06-10 | 5,500 | 1,101 | 150DB | 15.0000 | 440 | |||
| (3) HP 17.3" LAPTOPS | 2019-06-24 | 1,718 | 1,130 | 200DB | 5.0000 | 235 | |||
| WELL PUMP | 2018-11-14 | 1,833 | 1,338 | 200DB | 5.0000 | 198 | |||
| 2017 DODGE JOURNEY | 2019-08-08 | 20,074 | 4,804 | 200DB | 5.0000 | 474 | |||
| COMPUTER | 2020-06-03 | 1,000 | 520 | 200DB | 5.0000 | 192 |
| Category / Item | Cost / Other Basis | Accumulated Depreciation | Book Value | End of Year Fair Market Value |
|---|---|---|---|---|
| BUILDING & EQUIPMENT | 171,189 | 101,841 | 69,348 | |
| LAND | 10,000 | 10,000 |
| Item No. | 1 |
|---|---|
| Lender's Name | PSBT PROMISSORY NOTE |
| Lender's Title | |
| Relationship to Insider | |
| Original Amount of Loan | 30,000 |
| Balance Due | 14,060 |
| Date of Note | 2017-08 |
| Maturity Date | 2027-08 |
| Repayment Terms | 60 MONTHS |
| Interest Rate | 0.0475 |
| Security Provided by Borrower | |
| Purpose of Loan | TO REFINANCE PSBT COMMERCIAL LOC |
| Description of Lender Consideration | |
| Consideration FMV |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| EXPENSES | ||||
| FUEL | 3,772 | |||
| OFFICE SUPPLIES | 3,191 | |||
| WORKMANS COMPENSATION | 1,100 | |||
| FUNDRAISING EXPENSE | 1,060 | |||
| EQUIPMENT LEASE OR RENTAL | 90 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 51,324 | 51,324 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| INDIRECT OTHER PROFESSIONAL FEES | 1,203 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| INDIRECT TAXES/LICENSES | 5,059 |