| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| ACCOUNTING FEES | 1,000 | 0 | 0 |
| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| CASH VALUE OF INSURANCE POLICY | FMV | 1,743,310 | 1,743,310 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| INSURANCE POLICY PREMIUMS | 409,743 | 409,743 | 0 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| CASH VALUE INCREASE | 397,418 | 397,418 | 397,418 |
| Name | Address |
|---|---|
| CAROLYN J DAVIS |
3946 FRESHWIND CIRCLE WESTLAKE VILLAGE,CA91361 |