Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2015
Open to Public Inspection
For calendar year 2015, or tax year beginning 08-01-2015 , and ending 07-31-2016
Name of foundation
H SMITH FOR CITIZENS GENERAL HOSPITAL
 
Number and street (or P.O. box number if mail is not delivered to street address)620 LIBERTY AVENUE 10TH FLOOR
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PITTSBURGH, PA152222705
A Employer identification number

25-6069362
B Telephone number (see instructions)

(412) 768-5898
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$1,451,663
J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books
(b) Net investment
income
(c) Adjusted net
income
(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 31,510 31,510  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 126,544
b Gross sales price for all assets on line 6a 1,342,383
7 Capital gain net income (from Part IV, line 2)... 126,544
8 Net short-term capital gain......... 0
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... 849    
12 Total. Add lines 1 through 11........ 158,903 158,054  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 15,670 14,887   783
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... 864 132   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 16,534 15,019 0 783
25 Contributions, gifts, grants paid....... 63,746 63,746
26 Total expenses and disbursements. Add lines 24 and 25 80,280 15,019 0 64,529
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 78,623
b Net investment income (if negative, enter -0-) 143,035
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2015)
Form 990-PF (2015)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing.............      
2 Savings and temporary cash investments......... 8,940 64,900 64,900
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet0      
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 489,623 Click to see attachment373,858 501,199
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 701,586 Click to see attachment840,013 885,564
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,200,149 1,278,771 1,451,663
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable..................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).........   0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted..................    
25 Temporarily restricted...............    
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........ 1,197,849 1,275,608
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds 2,300 3,163
30 Total net assets or fund balances (see instructions)..... 1,200,149 1,278,771
31 Total liabilities and net assets/fund balances (see instructions). 1,200,149 1,278,771
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year’s return) ...............
1
1,200,149
2
Enter amount from Part I, line 27a .....................
2
78,623
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
1,278,772
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
1
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
1,278,771
Form 990-PF (2015)
Form 990-PF (2015)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b) How acquired
P—Purchase
D—Donation
(c) Date acquired
(mo., day, yr.)
(d) Date sold
(mo., day, yr.)
1 a 130. HANESBRANDS INC - W/I   2014-03-13 2015-08-04
b 60. HANESBRANDS INC - W/I   2014-03-13 2015-08-04
c 50. SKYWORKS SOLUTIONS INC COM   2014-03-20 2015-08-04
d 33. HANESBRANDS INC - W/I   2014-03-13 2015-08-05
e 38. HANESBRANDS INC - W/I   2014-03-13 2015-08-05
79. HANESBRANDS INC - W/I   2014-03-12 2015-08-05
18. CONOCOPHILLIPS   2014-05-22 2015-08-12
20. CONOCOPHILLIPS   2014-08-12 2015-08-12
98. CONOCOPHILLIPS   2013-08-27 2015-08-12
6. ALLSTATE CORP   2014-10-14 2015-08-13
85. ALLSTATE CORP   2014-10-13 2015-08-13
39. ALLSTATE CORP   2014-10-13 2015-08-14
54. BECTON DICKINSON & CO   2013-03-13 2015-08-20
25. CIGNA CORP   2014-07-14 2015-08-21
15. MCKESSON HBOC INC COMMN   2013-10-29 2015-08-21
35. BERKSHIRE HATHAWAY INC CLASS B   2015-01-23 2015-09-03
25. BERKSHIRE HATHAWAY INC CLASS B   2015-01-23 2015-09-04
800.427 PNC INTERNATIONAL EQUITY FUND CLASS I FUND 409   2014-03-05 2015-09-09
38. MCKESSON HBOC INC COMMN   2013-10-28 2015-09-14
35. CONSTELLATION BRANDS INC CL A   2014-05-16 2015-09-15
95. KROGER CO   2014-05-06 2015-09-15
35. VOYA FINL INC COM   2015-02-18 2015-10-14
30. DISNEY WALT CO   2014-02-20 2015-10-15
97. VOYA FINL INC COM   2015-02-17 2015-10-15
23. VOYA FINL INC COM   2015-02-17 2015-10-15
40. WYNDHAM WORLDWIDE CORP   2013-03-19 2015-10-15
47. HCA HOLDINGS INC   2014-07-18 2015-10-26
52. HCA HOLDINGS INC   2014-07-18 2015-10-27
46. HCA HOLDINGS INC   2014-07-18 2015-10-28
68. NXP SEMICONDUCTORS ISIN NL0009538784 SEDOL B505PN7   2013-11-26 2015-11-02
2. NXP SEMICONDUCTORS ISIN NL0009538784 SEDOL B505PN7   2013-11-27 2015-11-02
52. MAGNA INTERNATIONAL ISIN CA5592224011   2013-12-30 2015-11-09
69. MAGNA INTERNATIONAL ISIN CA5592224011   2013-12-30 2015-11-10
45. AETNA INC NEW   2013-05-30 2015-11-11
15. CIGNA CORP   2014-07-14 2015-11-11
1. MAGNA INTERNATIONAL ISIN CA5592224011   2014-01-03 2015-11-11
68. MAGNA INTERNATIONAL ISIN CA5592224011   2014-01-02 2015-11-11
10. SNAP-ON INC COM   2015-05-26 2015-11-16
20. SNAP-ON INC COM   2014-12-12 2015-11-16
6. SNAP-ON INC COM   2014-09-12 2015-11-16
4. SNAP-ON INC COM   2014-09-12 2015-11-17
85. ST JUDE MEDICAL INC   2014-02-20 2015-11-20
10. ST JUDE MEDICAL INC   2014-02-21 2015-11-20
5. ALTRIA GROUP INC   2013-05-13 2015-12-08
5. APPLE INC   2013-11-26 2015-12-08
5. CVS CAREMARK CORP   2013-02-21 2015-12-08
5. CELANESE CORP-SERIES A   2015-10-26 2015-12-08
10. CISCO SYS INC COM   2015-03-26 2015-12-08
5. COMCAST CORPORATION CL A   2014-07-22 2015-12-08
5. D R HORTON INC   2015-10-16 2015-12-08
5. DOW CHEMICAL CO   2015-04-29 2015-12-08
5. DR PEPPER SNAPPLE GROUP INC   2015-05-04 2015-12-08
5. EXXON MOBIL CORP   2014-11-17 2015-12-08
5. FOOT LOCKER INC   2014-04-02 2015-12-08
5. GENERAL ELEC CO COM   2010-01-26 2015-12-08
5. J P MORGAN CHASE & CO COM   2015-08-13 2015-12-08
5. KROGER CO   2014-05-06 2015-12-08
5. LINCOLN NATIONAL CORP   2014-09-12 2015-12-08
5. MICROSOFT CORP   2002-09-24 2015-12-08
5. MONDELEZ INTERNATIONAL   2015-09-15 2015-12-08
5. PFIZER INC COM   2015-10-27 2015-12-08
5. PRINCIPAL FINANCIAL GROUP COM   2015-08-13 2015-12-08
5. SCHLUMBERGER LTD COM   2014-03-31 2015-12-08
5. TOTAL FINA S A   2015-08-12 2015-12-08
5. VERIZON COMMUNICATIONS COM   2013-05-15 2015-12-08
5. WEC ENERGY GROUP INC   2009-02-26 2015-12-08
5. WELLS FARGO & CO NEW COM   2012-01-23 2015-12-08
5. INVESCO LTD ISIN BMG491BT1088 SEDOL B28XP76   2014-09-12 2015-12-08
5. TE CONNECTIVITY LTD SEDOL B62B7C3 ISIN CH0102993182   2014-06-25 2015-12-08
5. SIGNET JEWELERS LTD ISIN BMG812761002 SEDOL B3CTNK6   2015-11-10 2015-12-16
24. SIGNET JEWELERS LTD ISIN BMG812761002 SEDOL B3CTNK6   2015-11-10 2015-12-16
4. SIGNET JEWELERS LTD ISIN BMG812761002 SEDOL B3CTNK6   2015-11-09 2015-12-16
1. SIGNET JEWELERS LTD ISIN BMG812761002 SEDOL B3CTNK6   2015-11-09 2015-12-17
11. SIGNET JEWELERS LTD ISIN BMG812761002 SEDOL B3CTNK6   2015-11-09 2015-12-17
45. GOLDMAN SACHS GROUP INC COM   2015-05-13 2015-12-18
44. BOEING CO   2012-07-30 2016-01-29
109. MONDELEZ INTERNATIONAL   2015-09-15 2016-02-05
178. INVESCO LTD ISIN BMG491BT1088 SEDOL B28XP76   2013-05-08 2016-02-05
5. MONDELEZ INTERNATIONAL   2015-09-15 2016-02-08
26. MONDELEZ INTERNATIONAL   2015-09-15 2016-02-08
58. INVESCO LTD ISIN BMG491BT1088 SEDOL B28XP76   2013-05-08 2016-02-08
51. STANLEY BLACK & DECKER INC   2015-06-10 2016-02-16
3. STANLEY BLACK & DECKER INC   2015-06-10 2016-02-16
26. STANLEY BLACK & DECKER INC   2015-06-10 2016-02-17
11. AETNA INC NEW   2013-05-31 2016-03-10
20. ALASKA AIR GROUP INC   2015-11-17 2016-03-10
7. ALPHABET INC/CA-CL A   2015-11-02 2016-03-10
40. ALTRIA GROUP INC   2013-05-13 2016-03-10
22. AMERICAN ELECTRIC POWER INC   2015-10-15 2016-03-10
19. AMERICAN WATER WORKS CO INC   2016-02-09 2016-03-10
13. AMERIPRISE FINANCIAL INC   2015-01-23 2016-03-10
19. AMGEN INC   2014-01-17 2016-03-10
97. APPLE INC   2013-10-09 2016-03-10
293.843 ARTISAN SMALL CAP VALUE FUND MERGED 05/20/16   2015-11-19 2016-03-10
1402.339 ARTISAN SMALL CAP VALUE FUND MERGED 05/20/16   2006-01-09 2016-03-10
743.523 ARTISAN INTERNATIONAL FD-ADV   2009-10-05 2016-03-10
.891 BLACKROCK S&P 500 INDEX FUND   2015-12-10 2016-03-10
167.345 BLACKROCK S&P 500 INDEX FUND   2009-10-05 2016-03-10
14.999 BLACKROCK CORE BOND PORTFOLIO   2015-12-24 2016-03-10
9264.284 BLACKROCK CORE BOND PORTFOLIO   2000-02-23 2016-03-10
12. CIGNA CORP   2014-07-11 2016-03-10
25. CVS CAREMARK CORP   2013-02-21 2016-03-10
23. CELANESE CORP-SERIES A   2015-10-26 2016-03-10
17. CISCO SYS INC COM   2014-06-25 2016-03-10
110. CISCO SYS INC COM   2015-03-26 2016-03-10
31. CINTAS CORP   2015-03-27 2016-03-10
38. COMCAST CORPORATION CL A   2011-10-12 2016-03-10
17. CONSTELLATION BRANDS INC CL A   2014-05-16 2016-03-10
41. D R HORTON INC   2015-10-16 2016-03-10
27. DISNEY WALT CO   2014-02-07 2016-03-10
916.533 DODGE & COX INTERNATIONAL STOCK FUND   2009-10-05 2016-03-10
34. DOW CHEMICAL CO   2015-04-29 2016-03-10
20. DR PEPPER SNAPPLE GROUP INC   2015-05-04 2016-03-10
7. DR PEPPER SNAPPLE GROUP INC   2014-10-14 2016-03-10
32.728 EAGLE SMALL CAP GROWTH FUND CL I   2015-12-21 2016-03-10
476.791 EAGLE SMALL CAP GROWTH FUND CL I   2009-04-02 2016-03-10
39. EDWARDS LIFESCIENCES CORP   2015-02-06 2016-03-10
26. EXXON MOBIL CORP   2014-11-17 2016-03-10
965.244 FEDERATED STRATEGIC VALUE DIVIDEND FD CLASS A   2015-12-04 2016-03-10
18468.272 FEDERATED STRATEGIC VALUE DIVIDEND FD CLASS A   2010-11-08 2016-03-10
2430.292 FIDELITY ADVISOR FLOATING HIGH INCOME FUND I   2010-09-03 2016-03-10
30. FOOT LOCKER INC   2014-04-02 2016-03-10
15. GENERAL DYNAMICS CORP   2015-06-01 2016-03-10
58. GENERAL ELEC CO COM   2010-01-26 2016-03-10
17. GILEAD SCIENCES INC COM   2015-09-14 2016-03-10
3. HOME DEPOT INC COM   2012-01-09 2016-03-10
20. HOME DEPOT INC COM   2015-11-09 2016-03-10
28. HONEYWELL INTL INC   2015-05-26 2016-03-10
30. HORMEL FOODS CORP   2016-02-08 2016-03-10
15. ILLINOIS TOOL WORKS INC COM   2016-02-17 2016-03-10
28. J P MORGAN CHASE & CO COM   2014-09-30 2016-03-10
30. J P MORGAN CHASE & CO COM   2015-08-13 2016-03-10
32. JOHNSON & JOHNSON COM   2011-05-16 2016-03-10
65. KROGER CO   2014-05-06 2016-03-10
22. L BRANDS INC   2014-09-25 2016-03-10
21. LAM RESEARCH CORP   2015-06-01 2016-03-10
35. LINCOLN NATIONAL CORP   2014-09-12 2016-03-10
9. LOCKHEED MARTIN CORP   2013-11-25 2016-03-10
40. MICROSOFT CORP   2015-12-18 2016-03-10
34. NIKE INC CL B   2015-08-05 2016-03-10
15. NORTHROP GRUMMAN CORPORATION   2015-02-20 2016-03-10
10. O REILLY AUTOMOTIVE INC   2015-12-16 2016-03-10
20. PPG INDS INC COM   2015-03-02 2016-03-10
882.375 PNC INTERNATIONAL EQUITY FUND CLASS I FUND 409   2014-03-05 2016-03-10
85. PFIZER INC COM   2015-10-26 2016-03-10
40. PRINCIPAL FINANCIAL GROUP COM   2015-08-13 2016-03-10
7. PRINCIPAL FINANCIAL GROUP COM   2014-08-12 2016-03-10
7284.3 PRUDENTIAL TOTAL RETURN BD-Z   2015-07-10 2016-03-10
11. PUBLIC STORAGE INC   2015-09-03 2016-03-10
12. RAYTHEON COMPANY   2016-01-29 2016-03-10
22167.747 T ROWE PRICE SHORTTERM BD FD INC   2010-09-03 2016-03-10
1806.574 ROWE T PRICE MID CAP VALUE F COM   2002-09-24 2016-03-10
184.72 ROWE T PRICE MID CAP VALUE F COM   2015-12-15 2016-03-10
12. SCHLUMBERGER LTD COM   2015-05-04 2016-03-10
20. SCHLUMBERGER LTD COM   2014-03-31 2016-03-10
70. SKYWORKS SOLUTIONS INC COM   2014-03-21 2016-03-10
8. SNAP-ON INC COM   2014-09-12 2016-03-10
35. TEXAS INSTRS INC COM   2015-11-11 2016-03-10
10. THERMO ELECTRON CORP COM   2015-08-20 2016-03-10
28. TOTAL FINA S A   2015-08-12 2016-03-10
22. TRACTOR SUPPLY CO COM   2015-04-21 2016-03-10
25. THE TRAVELERS COS INC   2015-08-13 2016-03-10
1. THE TRAVELERS COS INC   2014-05-01 2016-03-10
8. UNIVERSAL HEALTH SERVICES INC CLASS B   2015-08-21 2016-03-10
292. VANGUARD FTSE EMERGING MARKETS ETF   2009-10-05 2016-03-10
50. VERIZON COMMUNICATIONS COM   2013-05-15 2016-03-10
28. VISA INC CLASS A SHARES   2013-02-08 2016-03-10
45. WEC ENERGY GROUP INC   2009-02-26 2016-03-10
65. WELLS FARGO & CO NEW COM   2009-08-13 2016-03-10
8432.583 WELLS FARGO CORE BOND FUND CLASS I   2010-09-03 2016-03-10
21. WYNDHAM WORLDWIDE CORP   2015-12-16 2016-03-10
18. ACCENTURE PLC CLASS A ISIN IE00B4BNMY34 SEDOL B4BNMY3   2015-07-13 2016-03-10
29. TE CONNECTIVITY LTD SEDOL B62B7C3 ISIN CH0102993182   2014-06-25 2016-03-10
19. CHECK POINT SOFTWARE COM   2014-08-29 2016-03-10
116. KROGER CO   2014-05-06 2016-03-14
32. SNAP-ON INC COM   2014-09-11 2016-03-17
1565.438 GOLDMAN SACHS GRTH OPPOR INSTIT CLASS   2016-03-10 2016-04-06
174. SECTOR SPDR TR SBI CONS STPLS   2016-03-10 2016-04-29
177. SECTOR SPDR TR SHS BEN INT-UTILITIES   2016-03-10 2016-04-29
37. AMERIPRISE FINANCIAL INC   2015-01-23 2016-05-02
52. APPLE INC   2006-08-08 2016-05-06
283. CISCO SYS INC COM   2011-11-11 2016-05-06
68. L BRANDS INC   2014-09-25 2016-05-06
25. MICROSOFT CORP   2015-12-18 2016-05-06
24. MICROSOFT CORP   2002-09-24 2016-05-06
145. LINCOLN NATIONAL CORP   2013-11-12 2016-05-20
84. THE TRAVELERS COS INC   2014-05-01 2016-05-20
367.497 COLUMBIA ACORN INTL FUND CL Z   2016-03-10 2016-05-26
33. GENERAL ELEC CO COM   2010-01-26 2016-05-26
1093.039 GOLDMAN SACHS MID CAP VALUE FD CL I   2016-03-10 2016-05-26
10. NORTHROP GRUMMAN CORPORATION   2015-07-20 2016-05-26
8. NORTHROP GRUMMAN CORPORATION   2015-02-19 2016-05-26
120. HORMEL FOODS CORP   2016-02-05 2016-06-03
2. AETNA INC NEW   2013-05-31 2016-06-06
2. ALASKA AIR GROUP INC   2015-11-17 2016-06-06
1. ALPHABET INC/CA-CL A   2015-11-02 2016-06-06
5. ALTRIA GROUP INC   2013-05-13 2016-06-06
37.038 AMERICAN BEACON L/C VALU IS   2016-03-10 2016-06-06
2. AMERICAN ELECTRIC POWER INC   2015-10-15 2016-06-06
3. AMERICAN WATER WORKS CO INC   2016-02-09 2016-06-06
2. AMGEN INC   2014-01-17 2016-06-06
5. APPLE INC   2006-08-08 2016-06-06
36.048 ARTISAN INTERNATIONAL FD-ADV   2009-10-05 2016-06-06
145.726 BAIRD MIDCAP INST   2016-04-06 2016-06-06
5. BANK NEW YORK MELLON CORP COM   2016-05-02 2016-06-06
1. CIGNA CORP   2014-07-11 2016-06-06
3. CVS CAREMARK CORP   2013-02-21 2016-06-06
3. CELANESE CORP-SERIES A   2015-07-10 2016-06-06
6. CISCO SYS INC COM   2011-11-11 2016-06-06
2. CINTAS CORP   2015-03-27 2016-06-06
5. COMCAST CORPORATION CL A   2011-10-12 2016-06-06
2. CONSTELLATION BRANDS INC CL A   2014-05-16 2016-06-06
34. DEUTSCHE X-TRACKERS MSCI EUR ETF   2016-03-10 2016-06-06
5. D R HORTON INC   2015-10-16 2016-06-06
3. DISNEY WALT CO   2014-02-07 2016-06-06
4. DOW CHEMICAL CO   2015-04-29 2016-06-06
3. DR PEPPER SNAPPLE GROUP INC   2014-10-14 2016-06-06
143.833 EATON VANCE FLOATING RATE FUND CLASS I   2016-03-10 2016-06-06
4. EDWARDS LIFESCIENCES CORP   2015-02-06 2016-06-06
3. EXXON MOBIL CORP   2014-11-17 2016-06-06
4. FACEBOOK INC A   2016-05-06 2016-06-06
3. FOOT LOCKER INC   2014-04-02 2016-06-06
13. FORD MTR CO DEL COM PAR $0.01   2016-05-06 2016-06-06
2. GENERAL DYNAMICS CORP   2015-05-27 2016-06-06
6. GENERAL ELEC CO COM   2010-01-26 2016-06-06
2. GILEAD SCIENCES INC COM   2015-09-14 2016-06-06
43.377 HARDING LOEVNER INTERNATIONAL EQUITY PORTFOLIO   2016-03-10 2016-06-06
3. HOME DEPOT INC COM   2012-01-09 2016-06-06
3. HONEYWELL INTL INC   2015-05-26 2016-06-06
2. ILLINOIS TOOL WORKS INC COM   2016-02-17 2016-06-06
2. ISHARES CORE US AGGREGATE BOND ETF   2016-03-10 2016-06-06
39. ISHARES MSCI EMERGING MKTS INDEX FUND   2016-03-10 2016-06-06
10. ISHARES TR S&P SMLCP VALU   2016-03-10 2016-06-06
8. ISHARES TR S&P SMLCP GROW   2016-03-10 2016-06-06
7. J P MORGAN CHASE & CO COM   2014-09-30 2016-06-06
3. JOHNSON & JOHNSON COM   2011-05-16 2016-06-06
3. KROGER CO   2014-05-07 2016-06-06
3. LAM RESEARCH CORP   2015-06-01 2016-06-06
85.141 MAINSTAY EPOCH GLOBAL EQUITY YIELD FUND CLASS I   2016-03-10 2016-06-06
4. MICROSOFT CORP   2002-09-24 2016-06-06
4. NIKE INC CL B   2015-08-05 2016-06-06
4. NORTHERN TRUST CORP   2016-05-20 2016-06-06
2. NORTHROP GRUMMAN CORPORATION   2015-02-19 2016-06-06
1. O REILLY AUTOMOTIVE INC   2015-12-16 2016-06-06
1. PPG INDS INC COM   2015-02-27 2016-06-06
2. PEPSICO INC COM   2016-06-03 2016-06-06
9. PFIZER INC COM   2015-10-26 2016-06-06
5. PRINCIPAL FINANCIAL GROUP COM   2014-08-12 2016-06-06
1. PUBLIC STORAGE INC   2015-09-03 2016-06-06
1. RAYTHEON COMPANY   2016-01-29 2016-06-06
30.036 ROWE T PRICE VALUE FD INC COM   2016-03-10 2016-06-06
27.86 T ROWE PRICE REAL ESTATE FUND FD 122   2016-03-10 2016-06-06
3. S&P GLOBAL INC   2016-05-20 2016-06-06
3. SCHLUMBERGER LTD COM   2015-05-04 2016-06-06
6. SECTOR SPDR TR SBI CONS STPLS   2016-03-10 2016-06-06
14. SECTOR SPDR TR SHS BEN INT-UTILITIES   2016-03-10 2016-06-06
1. SIMON PROPERTY GROUP INC   2016-03-17 2016-06-06
40.099 TEMPLETON INSTL FDS INC FOREIGN EQUITY SER   2016-03-10 2016-06-06
4. TEXAS INSTRS INC COM   2015-11-11 2016-06-06
2. THERMO ELECTRON CORP COM   2015-08-20 2016-06-06
8. TOTAL FINA S A   2015-08-12 2016-06-06
2. TRACTOR SUPPLY CO COM   2015-04-21 2016-06-06
3. TYSON FOODS INC CLASS A   2016-03-14 2016-06-06
1. UNIVERSAL HEALTH SERVICES INC CLASS B   2015-08-21 2016-06-06
76.927 VANGUARD TOTL BD MKT IDX-ADM   2016-03-10 2016-06-06
3. VANTIV INC CLASS A   2016-05-06 2016-06-06
6. VERIZON COMMUNICATIONS COM   2013-05-15 2016-06-06
2. VISA INC CLASS A SHARES   2013-02-08 2016-06-06
4. WEC ENERGY GROUP INC   2009-05-14 2016-06-06
6. WELLS FARGO & CO NEW COM   2009-08-13 2016-06-06
81.101 WELLS FARGO SPECIAL US MID CAP VALUE I   2016-05-26 2016-06-06
3. WYNDHAM WORLDWIDE CORP   2015-12-16 2016-06-06
1. ACCENTURE PLC CLASS A ISIN IE00B4BNMY34 SEDOL B4BNMY3   2015-07-13 2016-06-06
3. INGERSOLL-RAND PLC SEDOL: B633030   2016-05-26 2016-06-06
4. TE CONNECTIVITY LTD SEDOL B62B7C3 ISIN CH0102993182   2014-06-25 2016-06-06
2. CHECK POINT SOFTWARE COM   2014-08-29 2016-06-06
63. ALASKA AIR GROUP INC   2015-11-16 2016-06-16
10. CVS CAREMARK CORP   2013-02-21 2016-06-16
50. EDWARDS LIFESCIENCES CORP   2015-02-06 2016-06-24
173. PRINCIPAL FINANCIAL GROUP COM   2014-08-05 2016-06-24
97. FOOT LOCKER INC   2014-04-02 2016-06-30
227. SECTOR SPDR TR SBI CYCL TRANS   2016-04-29 2016-06-30
6. SECTOR SPDR TR SHS BEN INT-UTILITIES   2016-03-10 2016-06-30
112. TE CONNECTIVITY LTD SEDOL B62B7C3 ISIN CH0102993182   2014-01-28 2016-07-14
1. PFIZER INC XXX-XX-XXXX   2001-01-01 2016-07-19
22. CELANESE CORP-SERIES A   2015-07-10 2016-07-21
31. DOW CHEMICAL CO   2015-04-28 2016-07-21
20. PPG INDS INC COM   2015-02-27 2016-07-21
278.235 WASATCH INTL OPPORTUNIT-INST   2016-05-26 2016-07-27
CAPITAL GAIN DIVIDENDS P    
(e) Gross sales price (f) Depreciation allowed
(or allowable)
(g) Cost or other basis
plus expense of sale
(h) Gain or (loss)
(e) plus (f) minus (g)
a 3,794   2,420 1,374
b 1,756   1,107 649
c 4,397   1,928 2,469
d 957   609 348
e 1,105   701 404
2,287   1,455 832
924   1,415 -491
1,027   1,608 -581
5,056   6,520 -1,464
382   371 11
5,407   5,248 159
2,479   2,403 76
7,800   4,899 2,901
3,589   2,377 1,212
3,073   2,344 729
4,629   5,254 -625
3,234   3,736 -502
15,000   16,721 -1,721
7,457   5,841 1,616
4,501   3,014 1,487
3,526   2,205 1,321
1,361   1,527 -166
3,205   2,376 829
3,774   4,200 -426
892   989 -97
2,934   2,739 195
3,266   3,167 99
3,600   3,235 365
3,150   2,835 315
5,218   2,877 2,341
157   84 73
2,471   2,131 340
3,214   2,794 420
4,752   2,798 1,954
1,987   1,422 565
47   40 7
3,118   2,743 375
1,660   1,559 101
3,320   2,663 657
996   753 243
660   502 158
5,262   5,759 -497
626   677 -51
290   185 105
588   382 206
476   259 217
332   349 -17
272   272  
301   274 27
161   150 11
256   259 -3
461   381 80
375   475 -100
334   240 94
151   83 68
331   338 -7
207   116 91
267   274 -7
279   113 166
220   215 5
163   175 -12
242   285 -43
360   488 -128
231   254 -23
230   267 -37
251   103 148
273   154 119
164   204 -40
326   305 21
592   744 -152
2,810   3,573 -763
473   585 -112
117   146 -29
1,289   1,608 -319
7,927   9,056 -1,129
5,260   3,122 2,138
4,140   4,679 -539
4,820   6,378 -1,558
185   215 -30
946   1,116 -170
1,495   1,909 -414
4,743   5,474 -731
279   318 -39
2,417   2,760 -343
1,211   679 532
1,518   1,569 -51
5,115   5,209 -94
2,503   1,479 1,024
1,400   1,290 110
1,293   1,246 47
1,140   1,690 -550
2,666   2,371 295
9,815   7,049 2,766
3,012   3,118 -106
14,374   22,732 -8,358
19,763   14,633 5,130
213   218 -5
40,000   20,983 19,017
145   143 2
89,308   83,325 5,983
1,689   1,119 570
2,478   1,297 1,181
1,418   1,607 -189
465   421 44
3,007   2,992 15
2,706   2,620 86
2,226   1,987 239
2,393   1,397 996
1,144   1,230 -86
2,616   2,095 521
31,199   28,257 2,942
1,680   1,760 -80
1,837   1,524 313
643   450 193
1,546   1,650 -104
22,519   11,465 11,054
3,377   2,617 760
2,117   2,471 -354
5,685   5,328 357
108,778   84,699 24,079
22,067   23,332 -1,265
1,899   1,441 458
1,983   2,109 -126
1,739   963 776
1,502   1,858 -356
376   130 246
2,509   2,482 27
3,024   2,962 62
1,296   1,205 91
1,447   1,425 22
1,632   1,691 -59
1,748   2,030 -282
3,404   2,128 1,276
2,430   1,509 921
1,892   1,494 398
1,585   1,752 -167
1,333   1,918 -585
1,945   1,276 669
2,078   2,194 -116
1,981   1,989 -8
2,812   2,571 241
2,653   2,561 92
2,056   2,370 -314
15,380   18,433 -3,053
2,528   2,965 -437
1,526   2,278 -752
267   355 -88
102,636   103,000 -364
2,753   2,235 518
1,465   1,527 -62
104,188   108,100 -3,912
46,032   30,348 15,684
4,707   4,516 191
869   1,116 -247
1,449   1,953 -504
4,891   2,690 2,201
1,192   1,004 188
1,929   2,026 -97
1,385   1,330 55
1,282   1,420 -138
1,949   1,991 -42
2,774   2,680 94
111   91 20
912   1,127 -215
9,513   11,111 -1,598
2,605   2,674 -69
1,971   1,103 868
2,589   895 1,694
3,140   1,922 1,218
107,853   109,079 -1,226
1,543   1,549 -6
1,855   1,811 44
1,701   1,768 -67
1,578   1,343 235
4,452   2,688 1,764
4,981   4,002 979
36,522   34,627 1,895
9,072   9,036 36
8,495   8,492 3
3,533   4,798 -1,265
4,801   2,043 2,758
7,316   6,395 921
4,713   4,616 97
1,244   1,371 -127
1,195   544 651
6,530   7,183 -653
9,348   7,623 1,725
14,505   13,851 654
992   548 444
37,404   34,627 2,777
2,140   1,700 440
1,712   1,367 345
4,168   4,784 -616
243   123 120
129   157 -28
731   744 -13
325   185 140
655   615 40
131   117 14
227   197 30
319   238 81
493   46 447
1,022   709 313
2,292   2,206 86
212   201 11
129   93 36
288   156 132
214   208 6
175   114 61
190   165 25
317   118 199
308   164 144
864   824 40
154   150 4
296   227 69
215   207 8
277   193 84
1,250   1,202 48
405   268 137
267   285 -18
475   477 -2
163   144 19
170   175 -5
280   281 -1
180   100 80
175   219 -44
773   720 53
386   130 256
345   314 31
215   190 25
222   219 3
1,330   1,253 77
1,181   1,076 105
1,037   946 91
457   423 34
347   196 151
108   69 39
247   250 -3
1,544   1,478 66
208   91 117
217   234 -17
293   288 5
430   340 90
258   256 2
108   118 -10
205   205  
314   307 7
217   254 -37
257   203 54
133   127 6
967   918 49
781   755 26
331   325 6
234   279 -45
320   312 8
697   672 25
198   201 -3
755   716 39
244   232 12
307   266 41
385   406 -21
189   181 8
183   202 -19
136   141 -5
843   829 14
159   164 -5
305   321 -16
161   79 82
244   76 168
303   166 137
2,657   2,605 52
203   221 -18
119   101 18
196   200 -4
243   244 -1
170   141 29
3,792   4,886 -1,094
954   519 435
4,812   3,342 1,470
7,174   8,638 -1,464
5,313   4,652 661
17,635   17,917 -282
309   288 21
6,665   6,393 272
31   25 6
1,550   1,497 53
1,635   1,600 35
2,181   2,359 -178
821   801 20
      14,608
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69
(k) Excess of col. (i)
over col. (j), if any
a       1,374
b       649
c       2,469
d       348
e       404
      832
      -491
      -581
      -1,464
      11
      159
      76
      2,901
      1,212
      729
      -625
      -502
      -1,721
      1,616
      1,487
      1,321
      -166
      829
      -426
      -97
      195
      99
      365
      315
      2,341
      73
      340
      420
      1,954
      565
      7
      375
      101
      657
      243
      158
      -497
      -51
      105
      206
      217
      -17
       
      27
      11
      -3
      80
      -100
      94
      68
      -7
      91
      -7
      166
      5
      -12
      -43
      -128
      -23
      -37
      148
      119
      -40
      21
      -152
      -763
      -112
      -29
      -319
      -1,129
      2,138
      -539
      -1,558
      -30
      -170
      -414
      -731
      -39
      -343
      532
      -51
      -94
      1,024
      110
      47
      -550
      295
      2,766
      -106
      -8,358
      5,130
      -5
      19,017
      2
      5,983
      570
      1,181
      -189
      44
      15
      86
      239
      996
      -86
      521
      2,942
      -80
      313
      193
      -104
      11,054
      760
      -354
      357
      24,079
      -1,265
      458
      -126
      776
      -356
      246
      27
      62
      91
      22
      -59
      -282
      1,276
      921
      398
      -167
      -585
      669
      -116
      -8
      241
      92
      -314
      -3,053
      -437
      -752
      -88
      -364
      518
      -62
      -3,912
      15,684
      191
      -247
      -504
      2,201
      188
      -97
      55
      -138
      -42
      94
      20
      -215
      -1,598
      -69
      868
      1,694
      1,218
      -1,226
      -6
      44
      -67
      235
      1,764
      979
      1,895
      36
      3
      -1,265
      2,758
      921
      97
      -127
      651
      -653
      1,725
      654
      444
      2,777
      440
      345
      -616
      120
      -28
      -13
      140
      40
      14
      30
      81
      447
      313
      86
      11
      36
      132
      6
      61
      25
      199
      144
      40
      4
      69
      8
      84
      48
      137
      -18
      -2
      19
      -5
      -1
      80
      -44
      53
      256
      31
      25
      3
      77
      105
      91
      34
      151
      39
      -3
      66
      117
      -17
      5
      90
      2
      -10
       
      7
      -37
      54
      6
      49
      26
      6
      -45
      8
      25
      -3
      39
      12
      41
      -21
      8
      -19
      -5
      14
      -5
      -16
      82
      168
      137
      52
      -18
      18
      -4
      -1
      29
      -1,094
      435
      1,470
      -1,464
      661
      -282
      21
      272
      6
      53
      35
      -178
      20
       
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
Bracket 2 126,544
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ...................
Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2014 61,470 1,462,978 0.042017
2013 58,302 1,389,994 0.041944
2012 56,154 1,297,073 0.043293
2011 55,059 1,229,617 0.044777
2010 54,608 1,248,682 0.043733
2
Total of line 1, column (d) .....................
20.215764
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years . . .
3
0.043153
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
1,399,036
5
Multiply line 4 by line 3......................
5
60,373
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
1,430
7
Add lines 5 and 6........................
7
61,803
8
Enter qualifying distributions from Part XII, line 4.............
8
64,529
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form 990-PF (2015)
Form 990-PF (2015)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 1,430
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 1,430
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 1,430
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 1,464
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 1,464
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 34
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet34 RefundedBullet 11 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for definition)?.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
  • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletPA
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletPNC BANK NA Telephone no.bullet (412) 768-5898

    Located atbullet620 LIBERTY AVE 10TH FLOORPITTSBURGHPA ZIP+4bullet15222
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.......bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 2015, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country?
    16   No
    See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country bullet  
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)? ........
    1b
     
    No
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2015?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2015 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2015.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (Continued)
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? (see instructions)................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position
    (c) Compensation
    (If not paid, enter
    -0-)
    (d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    PNC BANK NA Trustee
    4
    15,670    
    620 Liberty Avenue 10th Floor
    Pittsburgh,PA15222
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position
    (c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation
    (e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    1,420,341
    b
    Average of monthly cash balances.......................
    1b
    0
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    1,420,341
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    1,420,341
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    21,305
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    1,399,036
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    69,952
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    69,952
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    1,430
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,430
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    68,522
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    68,522
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    68,522
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    64,529
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    b
    Cash distribution test (attach the required schedule) .................
    3b
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    64,529
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see instructions).................
    5
    1,430
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    63,099
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus
    (b)
    Years prior to 2014
    (c)
    2014
    (d)
    2015
    1 Distributable amount for 2015 from Part XI, line 7 68,522
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only....... 17,684
    b Total for prior years:2013, 20, 20 0
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 0
    b From 2011...... 0
    c From 2012...... 0
    d From 2013...... 0
    e From 2014...... 0
    fTotal of lines 3a through e........ 0
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 64,529
    a Applied to 2014, but not more than line 2a 17,684
    b Applied to undistributed income of prior years
    (Election required—see instructions).....
    0
    c Treated as distributions out of corpus (Election
    required—see instructions)........
    0
    d Applied to 2015 distributable amount..... 46,845
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2015. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........
    0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......
    0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........
    0
    e Undistributed income for 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............
    0
    f Undistributed income for 2016. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........
    21,677
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......
    0
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...
    0
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......
    0
    10 Analysis of line 9:
    a Excess from 2011.... 0
    b Excess from 2012.... 0
    c Excess from 2013.... 0
    d Excess from 2014.... 0
    e Excess from 2015.... 0
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2015, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........
    Tax year Prior 3 years (e) Total
    (a) 2015 (b) 2014 (c) 2013 (d) 2012
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....
             
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........
             
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....
             
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)
             
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...
             
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....
             
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....
             
    (3) Largest amount of support
    from an exempt organization
             
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    Foundation
    status of
    recipient
    Purpose of grant or
    contribution
    Amount
    Name and address (home or business)
    aPaid during the year
    CITIZENS GENERAL HOSPITAL
    HEALTH FOUNDATION
    651 FOURTH AVENUE
    NEW KENSINGTON,PA15068
    NONE PC GENERAL SUPPORT 63,746
    Total .................................bullet 3a 63,746
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code
    (b)
    Amount
    (c)
    Exclusion code
    (d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3
    Interest on savings and temporary cash investments ...........
             
    4 Dividends and interest from securities....     14 31,510  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6
    Net rental income or (loss) from personal property
             
    7 Other investment income.....          
    8
    Gain or (loss) from sales of assets other than inventory ............
        18 126,544  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue:
    aFEDERAL TAX REFUND
        14 849  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   158,903  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13158,903
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow
    Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    Firm's EIN SmallBullet
    Firm's address SmallBullet


    Phone no.
    Form 990-PF (2015)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2015 InvestmentsCorpStockSchedule
    Name:
    H SMITH FOR CITIZENS GENERAL HOSPITAL
    EIN:
    25-6069362
    Name of Stock End of Year Book Value End of Year Fair Market Value
    COMMON STOCK 373,858 501,199

    TY 2015 InvestmentsOtherSchedule2
    Name:
    H SMITH FOR CITIZENS GENERAL HOSPITAL
    EIN:
    25-6069362
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    MUTUAL FUNDS - FIXED AT COST 443,081 455,324
    MUTUAL FUNDS - EQUITY AT COST 396,932 430,240

    TY 2015 OtherDecreasesSchedule
    Name:
    H SMITH FOR CITIZENS GENERAL HOSPITAL
    EIN:
    25-6069362
    Description Amount
    ROUNDING ADJ FOR SALES AND TRANSACTIONS 1


    TY 2015 OtherIncomeSchedule2
    Name:
    H SMITH FOR CITIZENS GENERAL HOSPITAL
    EIN:
    25-6069362
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    FEDERAL TAX REFUND FROM PRIOR YEAR 849 0  


    TY 2015 TaxesSchedule
    Name:
    H SMITH FOR CITIZENS GENERAL HOSPITAL
    EIN:
    25-6069362
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 132 132   0
    FEDERAL ESTIMATES - PRINCIPAL 732 0   0