Form990-PF
Click to see attachment

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 07-01-2015 , and ending 06-30-2016
Name of foundation
HORTLEY G LEBLANG CHARITABLE FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)50 S FRANKLIN TURNPIKE
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
RAMSEY, NJ07446
A Employer identification number

13-3741369
B Telephone number (see instructions)

(201) 818-1515
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$1,145,078J 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 4 4
4 Dividends and interest from securities... 57,109 57,109 57,109
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 646
b Gross sales price for all assets on line 6a 26,667
7 Capital gain net income (from Part IV, line 2)... 646
8 Net short-term capital gain.........  
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).......      
12 Total. Add lines 1 through 11........ 57,759 57,759 57,113
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 2,791 2,791 2,791  
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 487      
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see list of attachments 360 360 360  
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 3,638 3,151 3,151 0
25 Contributions, gifts, grants paid....... 55,500 55,500
26 Total expenses and disbursements. Add lines 24 and 25 59,138 3,151 3,151 55,500
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -1,379
b Net investment income (if negative, enter -0-) 54,608
c Adjusted net income (if negative, enter -0-)... 53,962
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............. 8,941 12,744 12,744
2 Savings and temporary cash investments......... 23,890 8,077 8,077
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
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 bullet        
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)....... 921,774 958,168 1,124,257
c Investments—corporate bonds (attach schedule)....... 25,763    
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
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) 980,368 978,989 1,145,078
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.................. 980,368 978,989
25 Temporarily restricted...............    
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see instructions)..... 980,368 978,989
31 Total liabilities and net assets/fund balances (see instructions). 980,368 978,989
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
980,368
2
Enter amount from Part I, line 27a .....................
2
-1,379
3
Other increases not included in line 2 (itemize) bullet
3
 
4
Add lines 1, 2, and 3 ..........................
4
978,989
5
Decreases not included in line 2 (itemize) bullet
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
978,989
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 25,000 GE 5.25% DUE 12/6/17 P 2009-08-14 2015-05-16
b 20 THE CHEMOURS CO P 2011-07-11 2015-03-21
c
d
e
(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 26,545   25,763 782
b 122   258 -136
c
d
e
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       782
b       -136
c
d
e
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 2 646
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 50,260 1,144,403 0.04392
2013 49,690 1,068,168 0.04652
2012 44,510 1,007,008 0.04420
2011 47,950 972,460 0.04931
2010 42,850 978,725 0.04378
2
Total of line 1, column (d) .....................
20.227726
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
0.045545
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
1,094,224
5
Multiply line 4 by line 3......................
5
49,836
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
546
7
Add lines 5 and 6........................
7
50,382
8
Enter qualifying distributions from Part XII, line 4.............
8
55,500
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 1 546
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  
3 Add lines 1 and 2........................... 3 546
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 546
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a  
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7  
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. Click to see attachment 8 13
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 559
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet   RefundedBullet 11  
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
 
No
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)
    bulletNY
    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 ofbulletABRAHAM C KALKER TRUSTEE Telephone no.bullet (201) 818-1515

    Located atbullet50 S FRANKLIN TURNPIKERAMSEYNJ ZIP+4bullet07446
    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
     
    No
    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
     
    No
    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
     
    No
    .........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
     
    No
    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
    ABRAHAM C KALKER Trustee
    0.00     		0    
    50 S FRANKLIN TPKE
    RAMSEY,NJ07446
    TOBY KALKER Trustee
    0.00     		0    
    50 S FRANKLIN TPKE
    RAMSEY,NJ07446
    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  
    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.............bullet  
    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 SUPPORT OF OTHER TAX EXEMPT PUBLIC CHARITABLE RESEARCH AND RELIGIOUS ORGANIZATIONS 0
    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
    1,077,201
    b
    Average of monthly cash balances.......................
    1b
    33,686
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    1,110,887
    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
     
    3
    Subtract line 2 from line 1d.........................
    3
    1,110,887
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    16,663
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    1,094,224
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    54,711
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    54,711
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    546
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    546
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    54,165
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    54,165
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    54,165
    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
    55,500
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    55,500
    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
    546
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    54,954
    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 54,165
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only....... 55,389
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2015:
    a From 2010......  
    b From 2011......  
    c From 2012......  
    d From 2013......  
    e From 2014......  
    fTotal of lines 3a through e........  
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 55,500
    a Applied to 2014, but not more than line 2a 55,389
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		 
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2015 distributable amount..... 111
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2015.    
    (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  
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		 
    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......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2016. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........     		54,054
    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) .......     		 
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2011....  
    b Excess from 2012....  
    c Excess from 2013....  
    d Excess from 2014....  
    e Excess from 2015....  
    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
    ADOLPH SCHRIEBER HEBREW ACADEMY OF
    70 HIGHVIEW ROAD
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    ALZHEIMER'S ASSOCIATION
    400 MORRIS AVENUE STE 251
    DENVILLE,NJ07834     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    ALZHEIMER'S DISEASE RESEARCH
    22512 GATEWAY CENTER DRIVE
    CLARKSBURG,MD20871     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    AMERICAN CANCER SOCIETY
    6725 LYNS STREET
    EAST SYRACUSE,NY10305     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    AMERICAN COMMITTEE FOR SHAARE ZEDEK
    55 WEST 39TH ST 4TH FLOOR
    NEW YORK,NY10018     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    AMERICAN FRIENDS OF ALYN HOSPITAL
    51 EAST 42ND ST 308
    NEW YORK,NY10017     		NONE EXEMPT GENERAL EXEMPT PURPOSES 720
    AMERICAN RED MAGEN DAVID FOR ISRAEL
    352 SEVENTH AVE SUITE 400
    NEW YORK,NY10001     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    AMERICAN FRIENDS OF MIGDAL OHR
    1560 BROADWAY SUITE 807
    NEW YORK,NY10036     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    AMERICAN FRIENDS OF SHALVA
    315 FIFTH AVENUE 6TH FLOOR
    NEW YORK,NY10016     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    AMERICAN FRIENDS OF THE HEBREW UNIV
    PO BOX 2035
    NEW YORK,NY10021     		NONE EXEMPT GENERAL FUND PURPOSES 250
    AMERICAN FRIENDS OF YESHIVOT BNEI A
    11 BROADWAY 901
    NEW YORK,NY10004     		NONE EXEMPT GENERAL FUND PURPOSES 360
    AMERICAN HEART ASSOCIATION
    PO BOX 78851
    PHOENIX,AZ85062     		NONE EXEMPT GENERAL FUND PURPOSES 1,000
    AMERICAN PARKINSON DISEASE ASSOC IN
    135 PARKINSON AVENUE
    STATEN ISLAND,NY10305     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    AMERICAN RED CROSS NORTHERN NJ CHAP
    209 FAIRFIELD ROAD
    FAIRFIELD,NJ07004     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    BIKUR CHOLIM OF ROCKLAND
    25 ROBERT PITT DRIVE 101
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    BONEI OLAM
    1755 46TH STREET
    BROOKLYN,NY11204     		NONE EXEMPT GENERAL EXEMPT PURPOSES 360
    CAMP DORA GOLDING
    5515 NEW UTRECHT AVENUE
    BROOKLYN,NY11219     		NONE EXEMPT GENRAL EXEMPT PURPOSES 250
    CANCER CARE
    275 SEVENTH AVENUE
    NEW YORK,NY10001     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    CENTRAL FUND OF ISRAEL
    492-C CEDAR LANE 184
    TEANECK,NJ07666     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,800
    CHABAD OF BINGHAMTON
    420 MURRAY HILL ROAD
    VESTAL,NY13850     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    CHAI LIFELINE
    151 WEST 30TH STREET
    NEW YORK,NY10001     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    CHEVRA HATZOLOH OF FLATBUSH
    1880 OCEAN AVENUE
    BROOKLYN,NY11230     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    CONGREGATION OHAIV YISROEL
    30 BLUEBERRY HILL ROAD
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT FUNDS 1,000
    CONTEMPORARY WOMEN'S CLUB OF WASH T
    COOLIDGE AVENUE
    TWP OF WASHINGTON,NJ07676     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    EAST COAST GREENWAY ALLIANCE
    5315 HIGHTGATE DRIVE SUITE 105
    DURHAM,NC27713     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    EZER MIZION
    1281 49TH STREET
    BROOKLYN,NY11219     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    FRIENDS OF JERUSALEM COLLEGE OF TEC
    358 FIFTH AVENUE SUITE 1406
    NEW YORK,NY10001     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    FRISCH SCHOOL
    120 WEST CENTURY ROAD
    PARAMUS,NJ07652     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    GESHER FOUNDATION
    332 BLEEKER STREET
    NEW YORK,NY10014     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    HATZOLAH EMS OF ROCKLAND
    19 GROVE ST POB 184
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    HEBREW FREE BURIAL ASSOCIATION
    224 WEST 35TH ST ROOM 300
    NEW YORK,NY10001     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    JCC OF ROCKLAND
    450 WEST NYACK ROAD
    WEST NYACK,NY10994     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    JEP OF ROCKLAND
    84-B RT 59 PO BOX 196
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,500
    JEWISH BRAILLE INSTITUTE
    110 EAST 30TH STREET
    NEW YORK,NY10016     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    LIGHTHOUSEJEWISH GUILD FOR THE BLIN
    15 WEST 65TH STREET
    NEW YORK,NY10023     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    JEWISH MUSEUM
    1109 FIFTH AVENUE
    NEW YORK,NY10128     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    JEWISH NATIONAL FUND
    42 EAST 69TH STREET
    NEW YORK,NY10021     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,540
    JUST ONE LIFE
    587 FIFTH AVENUE
    NEW YORK,NY10017     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    KEHILLAS BAIS YEHUDAH
    23 LIME KILN ROAD
    WESLEY HILLS,NY10901     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,500
    KUPATH EZRAH
    59 COLLEGE ROAD POB 3
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    LANIADO HOSPITAL
    261 WEST 35TH STREET SUITE 803
    NEW YORK,NY10001     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    MEALS ON WHEELS
    121 WEST NYACK ROAD
    NANUET,NY10954     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    MEMORIAL SLOAN-KETTERING CANCER CEN
    1275 YORK AVENUE
    NEW YORK,NY10065     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    NATIONAL COUNCIL JEWISH WOMEN
    475 RIVERSIDE DRIVE SUITE 1901
    NEW YORK,NY10115     		NONE EXEMPT GENERAL EXEMPT PURPOSES 5,000
    NATIONAL MULTIPLE SCLEROSIS SOCIETY
    1 KALISA WAY SUITE 205
    PARAMUS,NJ07652     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    NATURE CONSERVANCY
    4245 N FAIRFAX DRIVE SUITE 4245
    ARLINGTON,VA22203     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    NEW SYNAGOGUE OF FT LEE
    1585 CENTER AVENUE
    FORT LEE,NJ07024     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    NOAM SHABBOS ASSOCIATION
    1701-45TH STREET
    BROOKLYN,NY11204     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    OHR DAVID OUTREACH
    326 KINGSTON AVENUE
    BROOKLYN,NY11213     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    PARKINSON'S DISEASE FOUNDATION
    1359 BROADWAY WUITE 1509
    NEW YORK,NY10018     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    RAILS TO TRAILS
    221 WARD COURT NW 5TH FLOOR
    WASHINGTON,DC20037     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    RAMSEY RESCUE SQUAD
    PO BOX 193
    RAMSEY,NJ07446     		NONE EXEMPT GENERAL EXEMPT PURPOSES 100
    ROSA 4 ROCKLAND
    PO BOX 712
    POMONA,NY10970     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    SATMAR BIKUR CHOLIM
    545 BEDFORD AVENUE
    BROOKLYN,NY11211     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    SIERRA CLUB
    PO BOX 421042
    PALM COAST,FL32142     		NONE EXEMPT GENERAL EXEMPT PURPOSES 150
    SPRING HILL AMBULANCE SERVICES
    48 BRICK CHURCH ROAD
    SPRING VALLEY,NY10977     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    TOMCHE SHABBOS OF ROCKLAND
    PO BOX 4847
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT PURPOSES 3,000
    US HOLOCAUST MUSEUM
    100 RAOUL WALLENBERG PLACE SW
    WASHINGTON,DC20024     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    UJA FEDERATION OF NY
    130 EAST 59TH STREET
    NEW YORK,NY10022     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    YESHIVA OF FLATBUSH
    919 EAST 10TH STREET
    BROOKLYN,NY11230     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    AMERICAN FRIENDS OF YAD SARAH
    450 PARK AVENUE SOUTH
    NEW YORK,NY10022     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    RAMSEY VOLUNTEER AMBULANCE
    41 SOUTH ISLAND AVENUE
    RAMSEY,NJ07446     		NONE EXEMPT GENERAL EXEMPT PURPOSES 100
    ROCKLAND ERUV
    PO BOX 1161
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT PURPOSES 180
    FRIENDS OF THE SMITHSONIAN
    PO BOX 9016
    PITTSFIELD,MA01202     		NONE EXEMPT GENERAL EXEMPT PURPOSES 150
    SOARING SOCIETY OF AMERICA INC
    PO BOX 2100
    HOBBS,NM88241     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    YESHIVA HAR TORAH
    250-10 GRAND CENTRAL PARKWAY
    LITTLE NECK,NY10022     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,500
    HOLOCAUST MUSEUM STUDY CENTER
    145 COLLEGE ROAD ROOM 6103
    SUFFERN,NY10901     		NONE EXEMPT GENERAL EXEMPT PURPOSES 150
    YESHIVA OF NORTH JERSEY
    666 KINDERKAMACK ROAD
    RIVER EDGE,NJ07661     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    YAD EZRA
    12A NORTH AIRMONT ROAD
    SUFFERN,NY10901     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    A-TIME
    1310 48TH STREET
    BROOKLYN,NY11219     		NONE EXEMPT GENERAL EXEMPT PURPOSES 180
    MISASKIM
    5805 16TH AVENUE
    BROOKLYN,NY11204     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    ROCKLAND JEWISH FAMILY SERVICE
    450 W NYACK ROAD
    W NYACK,NY10994     		NONE EXEMPT GENERAL OPERATING PURPOSES 500
    TOURO SYNAGOGUE
    85 TOURO STREET
    NEWPORT,RI02840     		NONE EXEMPT GENERAL EXEMPT PURPOSES 360
    AMERICAN FRIENDS OF SHAAREI MARPE
    1184 EAST 28TH STREET
    BROOKLYN,NY11210     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    AMIT WOMEN
    817 BROADWAY
    NEW YORK,NY10003     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    CHAI4EVER
    1221 MADISON AVENUE
    LAKEWOOD,NJ08701     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    COLONIAL WILLIAMSBURG FOUNDATION
    PO BOX 1776
    WILLIAMSBURG,VA23187     		NONE EXEMPT GENERAL EXEMPT PURPOSES 100
    COMMUNITY MIKVEH OF ROCKALND
    238 VIOLA ROAD
    MONSEY,NY10952     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    EMUNAH OF AMERICA
    363 7TH AVENUE
    NEW YORK,NY10001     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    FOOD BANK OF THE HUDSON VALLEY
    195 HUDSON STREET
    CORNWALL ON HUDSON,NY12520     		NONE EXEMPT GENERAL EXEMPT PURPOSES 250
    HAVENS RELIEF SOCIETY
    475 RIVERSIDE DRIVE
    NEW YORK,NY10115     		NONE EXEMPT GENERAL EXEMPT PURPOSES 100
    HEBREW ACADEMY FOR SPECIAL CHILDREN
    40 GRANDVIEW AVENUE
    SPRING VALLEY,NY10977     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    HEBREW ACADEMY OF NASSAU COUNTY
    609 HEMPSTEAD AVENUE
    WEST HEMPSTEAD,NY11552     		NONE EXEMPT GENERAL EXEMPT PURPOSES 1,000
    LONE SOLDIER CENTER
    1500 BROADWAY
    NEW YORK,NY10036     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    NATIONAL PARKS CONSERVATION ASSOCIA
    777 6TH STREET NW
    WASHINGTON,DC20001     		NONE EXEMPT GENERAL EXEMPT PURPOSES 100
    NEWPORT PRESERVATION SOCIETY
    424 BELLEVUE AVENUE
    NEWPORT,RI02840     		NONE EXEMPT GENERAL EXEMPT PURPOSES 100
    RAMAPO VALLEY AMBUALNCE CORPS
    235 ROUTE 59
    SUFFERN,NY10901     		NONE EXEMPT GENERAL EXEMPT PURPOSES 100
    RAMSEY VOLUNTEER FIRE DEPARTMENT
    25 S ISLAND AVENUE
    RAMSEY,NJ07446     		NONE EXEMPT GENERAL EXEMPT PURPOSES 100
    VALLEY SOARING CLUB
    100 AIRPORT ROAD
    NEW HAMPTON,NY10958     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    WEINBAUM YESHIVA
    7902 N MONTOYA CIRCLE
    BOCA RATON,FL33433     		NONE EXEMPT GENERAL EXEMPT PURPOSES 500
    Total .................................bullet 3a 55,500
    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 ...........     		    14 4  
    4 Dividends and interest from securities....     14 57,109  
    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 ............     		        646
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   57,113 646
    13Total. Add line 12, columns (b), (d), and (e)..................
    1357,759
    (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: 15000324
    Software Version: 2015v2.0


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2015 OtherExpensesSchedule
    Name:
    HORTLEY G LEBLANG CHARITABLE FOUNDATION
    EIN:
    13-3741369
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    bank charges 110 110 110  
    NYS FILING FEES 250 250 250  


    TY 2015 OtherProfessionalFeesSchedule
    Name:
    HORTLEY G LEBLANG CHARITABLE FOUNDATION
    EIN:
    13-3741369
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    MANAGED ACCOUNT FEES 2,791 2,791 2,791 0


    TY 2015 TaxesSchedule
    Name:
    HORTLEY G LEBLANG CHARITABLE FOUNDATION
    EIN:
    13-3741369
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    federal excise tax 487