EOANF-PERAC

Contact Information

Form Completed By:(Required)

First Last

Email:(Required)

Enter Email Confirm Email

Phone:(Required)

Fund and Board Information

Retirement Board:(Required)

Please select from the list

Name of Fund:(Required)

Please select from the list. If your fund is not listed, select "fund not listed" and enter your fund name in the next field.

Enter the Fund Name:(Required)

Complete this question ONLY if fund is not in the previous list.

Filed By:(Required)

This is a(Required)

Quarterly Statement

Monthly Statement

Beginning Market Value

Market Value at Beginning of Period:(Required)

PLUS

1. Purchases by the System

Note: includes Capital Calls and Reinvestments

Purchases by System / Date 1:

Enter Month, Day, and Year

Purchases / Amount 1:

Please enter a number greater than or equal to 0.

Purchases by System / Date 2:

Enter Month, Day, and Year

Purchases / Amount 2:

Please enter a number greater than or equal to 0.

Purchases by System / Date 3:

Enter Month, Day, and Year

Purchases / Amount 3:

Please enter a number greater than or equal to 0.

1. Total Purchases by System

2. Changes Due to Income

Note: if a loss, enter as a negative number.

Investment Income (Loss):

Realized Gain (Loss):

Unrealized Gain (Loss):

2. Total Changes Due to Income

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Subtotal - purchases and changes

LESS

3. Investment Related Fees

Management Fees (5304):

Please enter a number greater than or equal to 0.

Carried Interest Expense (4701):

Equalization Expense (4702):

Please enter a number greater than or equal to 0.

Misc. Investment Expense (4703):

Please enter a number greater than or equal to 0.

3. Total Investment Related Fees

4. Sales by System

Note: includes income not reinvested and Distributions

Sales by System / Date 1:

Enter Month, Day, and Year

Sales by System / Amount 1:

Please enter a number greater than or equal to 0.

Sales by System / Date 2:

Enter Month, Day, and Year

Sales by System / Amount 2:

Please enter a number greater than or equal to 0.

Sales by System / Date 3:

Enter Month, Day, and Year

Sales by System / Amount 3:

Please enter a number greater than or equal to 0.

4. Total Sales by System

5. Other

Note: enter negative number for refunds/losses.

Name/Type 1:

Date 1:

Enter Month, Day, and Year

Amount 1 expense/credit (refund/loss):

Name/Type 2:

Date 2:

Enter Month, Day, and Year

Amount 2 expense/credit (refund/loss):

Name/Type 3:

Date 3:

Enter Month, Day, and Year

Amount 3 expense/credit (refund/loss):

5. Total Reinvestment/Other

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Subtotal - loss to fund

Ending Market Value

Market Value at End of Period:(Required)

Comments: