| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| ANNUITIES-JACKSON NATIONAL LIFE INS OF NEW YORK | 373,782 | 406,204 | |
| UBS SELECT GOVERNMENT INSTITUTIONAL FUND | 4,074 | 4,074 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Amortization | 0 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| DISTRIBUTIONS FROM ANNUITIES | 25,510 | 25,510 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| IRS | 380 | |||
| NYS FILING FEE | 100 | 50 | 50 |