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 01-01-2015 , and ending 12-31-2015
Name of foundation
RAMSAYE HELENE MEDICAL TRUST 31H076015
 
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 477
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CONCORD, NH033020477
A Employer identification number

22-6333204
B Telephone number (see instructions)

(973) 425-8942
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$1,603,785J 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... 34,897 34,897  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 64,989
b Gross sales price for all assets on line 6a 652,261
7 Capital gain net income (from Part IV, line 2)... 64,989
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).......      
12 Total. Add lines 1 through 11........ 99,886 99,886  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 24,187 24,187    
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule)......... Click to see attachment 1,794 1,794 0 0
b Accounting fees (attach schedule)....... Click to see attachment 725 725 0 0
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 1,963 479   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.......... 28,669 27,185 0 0
25 Contributions, gifts, grants paid....... 93,891 93,891
26 Total expenses and disbursements. Add lines 24 and 25 122,560 27,185 0 93,891
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -22,674
b Net investment income (if negative, enter -0-) 72,701
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......... 105,241 32,158 32,158
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) 234,474 Click to see attachment296,521 294,858
b Investments—corporate stock (attach schedule)....... 983,319 Click to see attachment949,587 1,043,994
c Investments—corporate bonds (attach schedule)....... 213,367 Click to see attachment234,558 232,775
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........     0
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) 1,536,401 1,512,824 1,603,785
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........ 1,536,401 1,512,824
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)..... 1,536,401 1,512,824
31 Total liabilities and net assets/fund balances (see instructions). 1,536,401 1,512,824
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
1,536,401
2
Enter amount from Part I, line 27a .....................
2
-22,674
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
1,513,727
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
903
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
1,512,824
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 68. CALIFORNIA RESOURCES CORPORATION   2014-07-25 2015-01-13
b 987.959 BUFFALO SMALL CAP FD #1444   2013-06-13 2015-01-26
c 1127.92 HARTFORD MUT FDS INC MIDCAP FD CL Y FD# 229   2013-06-13 2015-01-26
d 1361.96 PERKINS MID CAP VALUE FUND INSTITUTIONAL CLASS   2013-06-13 2015-01-26
e 1375.787 ROYCE SPECIAL EQUITY FD #327   2013-06-13 2015-01-26
1151.346 VANGUARD INFLTN PRTCTD SEC FD #5119   2013-06-13 2015-01-26
40. AMERISOURCEBERGEN CORP   2014-06-13 2015-01-29
80. SMUCKER J M CO NEW   2014-01-31 2015-02-06
90. KOHL'S CORP   2014-01-31 2015-02-12
60. CVS CORP   2013-11-21 2015-02-19
40. APPLE COMPUTER, INC   2013-06-27 2015-02-20
5000. AT&T INC 4.45% 05/15/2021 DTD 04/29/11   2011-05-11 2015-02-26
5000. GEN ELEC CAP CORP 1.625% 07/02/2015 DTD 07/02/2012   2012-09-06 2015-02-26
10000. WAL-MART STORES INC 1.50% 10/25/2015 DTD 10/25/10   2012-10-25 2015-02-26
100. NATIONAL-OILWELL INC   2013-11-21 2015-03-17
100. NATIONAL-OILWELL INC   2014-01-31 2015-03-18
10000. COCA COLA CO 1.500% 11/15/2015 DTD 11/15/10   2010-12-15 2015-04-02
100. CME GROUP INC   2013-11-21 2015-04-06
155. EXXON MOBIL CORP COM   2001-11-30 2015-04-08
60. ABBOTT LABS CO   2013-01-15 2015-04-09
20. ABBVIE INC   2014-01-31 2015-04-09
90. AGILENT TECHNOLOGIES INC COM   2014-01-31 2015-04-09
30. AMERICAN EXPRESS CO   2015-01-20 2015-04-09
60. AMERICAN INTL GROUP INC COM NEW   2014-10-29 2015-04-09
10. AMERICAN INTL GROUP INC COM NEW   2013-11-21 2015-04-09
20. AMERISOURCEBERGEN CORP   2014-05-19 2015-04-09
20. AMERIPRISE FINANCIAL INC   2015-02-04 2015-04-09
30. ANADARKO PETROLEUM   2015-04-08 2015-04-09
50. APPLE COMPUTER, INC   2013-06-27 2015-04-09
120. APPLIED MATERIALS   2013-11-21 2015-04-09
10. BLACKROCK INC CL A   2013-11-21 2015-04-09
40. BOEING CO   2014-01-31 2015-04-09
50. CIT GROUP INC COM NEW   2013-11-21 2015-04-09
20. CME GROUP INC   2013-11-21 2015-04-09
30. CVS CORP   2013-11-21 2015-04-09
40. CAMERON INTERNATIONAL CORP   2014-01-31 2015-04-09
70. CENTURYTEL INC COM   2013-11-21 2015-04-09
40. CITIGROUP INC.   2014-10-29 2015-04-09
30. CITIGROUP INC.   2014-01-31 2015-04-09
40. CITIZENS FINANCIAL GROUP INC   2015-03-30 2015-04-09
40. CITRIX SYS INC COM   2014-04-24 2015-04-09
20. COLGATE PALMOLIVE CO   2009-01-09 2015-04-09
50. COMCAST CORP SPECIAL CL A   2014-01-31 2015-04-09
50. DANAHER CORP   2011-04-21 2015-04-09
10. DEVON ENERGY CORPORATIOIN NE COM   2014-08-26 2015-04-09
30. DEVON ENERGY CORPORATIOIN NE COM   2014-01-31 2015-04-09
40. E I DUPONT DE NEMOURS INC   2014-01-31 2015-04-09
10. ECOLAB INC COM   2010-05-14 2015-04-09
40. EVERSOURCE ENERGY   2014-01-31 2015-04-09
50. FIDELITY NATL INFORMATION SV   2013-11-21 2015-04-09
30. GENUINE PARTS CO   2014-01-31 2015-04-09
10. HOME DEPOT INC   2014-06-18 2015-04-09
50. INTERNATIONAL PAPER CO   2013-08-16 2015-04-09
30. KOHL'S CORP   2014-01-31 2015-04-09
10. LAS VEGAS SANDS CORP COM   2014-10-30 2015-04-09
60. MARSH & MCLENNAN CORP   2014-01-31 2015-04-09
20. MCDONALDS CORP   2014-01-31 2015-04-09
60. METLIFE INC   2014-06-17 2015-04-09
120. MICROSOFT CORPORATION   2014-01-31 2015-04-09
70. MORGAN STANLEY GROUP INC. DEAN   2014-03-13 2015-04-09
30. NORTHERN TRUST CORP   2014-01-31 2015-04-09
10. OCCIDENTAL PETROLEUM CO   2014-01-31 2015-04-09
20. OCCIDENTAL PETROLEUM CO   2014-07-25 2015-04-09
90. ORACLE CORPORATION   2012-09-13 2015-04-09
30. PEPSICO INCORPORATED   2014-01-31 2015-04-09
20. PRAXAIR INCORPORATED COMMON   2013-11-21 2015-04-09
40. ROCKWELL COLLINS INC COM   2014-10-28 2015-04-09
40. SYNCHRONY FINANCIAL   2015-02-12 2015-04-09
50. TJX COMPANIES INC.   2014-01-31 2015-04-09
70. TEXAS INSTRUMENTS   2013-11-21 2015-04-09
60. TIME WARNER INC   2013-11-21 2015-04-09
20. UNITED TECHNOLOGIES   2013-11-21 2015-04-09
30. UNITEDHEALTH GROUP INC COM   2013-11-21 2015-04-09
30. VISA INC. - CL A   2015-02-04 2015-04-09
60. WISCONSIN ENERGY CORP   2014-01-31 2015-04-09
60. INGERSOLL-RAND PLC SHS   2013-11-21 2015-04-09
10. SEAGATE TECHNOLOGY PLC SHS   2014-02-03 2015-04-09
30. SEAGATE TECHNOLOGY PLC SHS   2015-01-27 2015-04-09
40. CHECK POINT SOFTWARE TECHNOLOGIES LTD   2014-08-28 2015-04-09
10. NIELSEN N V   2015-04-06 2015-04-09
70. AMERISOURCEBERGEN CORP   2014-05-12 2015-04-20
10. BLACKROCK INC CL A   2013-11-21 2015-05-22
80. CENTURYTEL INC COM   2013-11-21 2015-05-22
120. COMCAST CORP SPECIAL CL A   2014-01-31 2015-05-22
90. MARSH & MCLENNAN CORP   2014-01-31 2015-05-22
50. MICROSOFT CORPORATION   2013-05-20 2015-05-27
20. CHECK POINT SOFTWARE TECHNOLOGIES LTD   2011-07-14 2015-05-27
20. CHECK POINT SOFTWARE TECHNOLOGIES LTD   2014-08-28 2015-05-27
30. MARSH & MCLENNAN CORP   2014-01-31 2015-06-04
20. ORACLE CORPORATION   2011-06-15 2015-06-04
10000. U S TREASURY NOTE 4.875% 08/15/2016 DTD 08/15/2006   2012-03-14 2015-06-19
32. CHEMOURS COMPANY   2014-01-31 2015-07-09
40. LAS VEGAS SANDS CORP COM   2014-10-30 2015-07-15
50. LAS VEGAS SANDS CORP COM   2015-04-30 2015-07-23
10. AMERICAN EXPRESS CO   2015-01-20 2015-07-27
90. AMERICAN EXPRESS CO   2014-02-04 2015-07-27
50. AMERICAN EXPRESS CO   2009-05-19 2015-07-29
30. CITRIX SYS INC COM   2014-01-31 2015-07-30
10. CVS CORP   2013-11-21 2015-08-06
130. AGILENT TECHNOLOGIES INC COM   2013-08-16 2015-08-18
120. AGILENT TECHNOLOGIES INC COM   2013-08-16 2015-08-19
10000. CATERPILLAR FINL SE 2.05% 08/01/2016 DTD 07/29/2011   2013-06-18 2015-08-21
5000. COMCAST CORP 2.85% 01/15/2023 DTD 01/14/2013   2013-02-22 2015-08-21
5000. ONTARIO PROVINCE OF 1.65% 09/27/2019 DTD 09/27/2012   2015-01-27 2015-08-21
5000. U S TREASURY NOTE 4.875% 08/15/2016 DTD 08/15/2006   2012-03-14 2015-08-21
100. PRAXAIR INCORPORATED COMMON   2014-01-31 2015-08-24
130. CAMERON INTERNATIONAL CORP   2014-01-31 2015-08-26
15000. U S TREASURY NOTE 4.875% 08/15/2016 DTD 08/15/2006   2012-03-22 2015-09-16
190. METLIFE INC   2014-06-17 2015-10-05
50. MCDONALDS CORP   2014-01-31 2015-10-09
70. CIT GROUP INC COM NEW   2013-11-21 2015-10-16
30. HOME DEPOT INC   2014-06-18 2015-10-22
40. MCDONALDS CORP   2014-01-31 2015-10-26
30. MCDONALDS CORP   2014-01-31 2015-10-27
70. TEXAS INSTRUMENTS   2013-11-21 2015-10-28
10000. GEN ELEC CAP CORP 5.625% 09/15/2017 DTD 09/24/07   2011-03-30 2015-10-30
5000. GEN ELEC CAP CORP 5.625% 09/15/2017 DTD 09/24/07   2015-04-09 2015-10-30
4000. GENERAL ELEC CAP 3.45% 05/15/2024 DTD 05/15/2014 CALLABLE 02/13/   2015-02-26 2015-10-30
80. CITRIX SYS INC COM   2014-01-31 2015-11-13
16000. GE CAP INTL FNDG 0.9640% 04/15/2016 DTD 10/26/2015   2015-10-30 2015-11-16
1000. GENERAL ELEC CAP 3.45% 05/15/2024 DTD 05/15/2014 CALLABLE 02/13/   2015-02-26 2015-11-16
5000. U S TREASURY NOTE 4.875% 08/15/2016 DTD 08/15/2006   2015-01-26 2015-11-16
10000. U S TREASURY NOTE 4.875% 08/15/2016 DTD 08/15/2006   2013-06-13 2015-11-16
50. CITRIX SYS INC COM   2014-02-03 2015-11-20
210. INTERNATIONAL PAPER CO   2014-01-31 2015-12-02
100. UNITED TECHNOLOGIES   2014-10-28 2015-12-07
30. NORTHERN TRUST CORP   2014-01-31 2015-12-31
20. VISA INC. - CL A   2014-01-31 2015-12-31
10. VISA INC. - CL A   2015-02-04 2015-12-31
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 279   529 -250
b 31,131   26,850 4,281
c 32,800   26,411 6,389
d 27,212   30,799 -3,587
e 30,928   29,294 1,634
30,292   31,104 -812
3,812   2,846 966
9,053   7,755 1,298
6,196   4,532 1,664
6,156   3,965 2,191
5,166   2,257 2,909
5,404   5,079 325
5,021   5,048 -27
10,077   10,177 -100
4,776   7,542 -2,766
4,751   7,461 -2,710
10,066   9,655 411
9,259   8,310 949
13,051   5,831 7,220
2,824   1,997 827
1,203   996 207
3,824   3,706 118
2,374   2,632 -258
3,378   3,150 228
563   487 76
2,271   1,386 885
2,498   2,648 -150
2,677   2,584 93
6,307   2,821 3,486
2,685   2,030 655
3,713   3,023 690
6,124   4,701 1,423
2,276   2,486 -210
1,817   1,662 155
3,061   1,983 1,078
1,931   2,413 -482
2,509   2,175 334
2,082   2,095 -13
1,561   1,433 128
999   974 25
2,580   2,428 152
1,399   651 748
2,955   2,587 368
4,275   2,663 1,612
650   748 -98
1,949   1,776 173
2,878   2,442 436
1,157   477 680
1,998   1,749 249
3,407   2,542 865
2,789   2,439 350
1,147   800 347
2,728   2,364 364
2,325   1,511 814
595   617 -22
3,413   2,739 674
1,929   1,868 61
3,090   3,362 -272
4,978   4,427 551
2,565   2,199 366
2,131   1,802 329
779   848 -69
1,558   1,934 -376
3,890   2,873 1,017
2,891   2,407 484
2,449   2,502 -53
3,889   3,276 613
1,202   1,357 -155
3,432   2,843 589
4,035   2,959 1,076
5,138   3,836 1,302
2,358   2,193 165
3,560   2,208 1,352
1,989   1,986 3
2,937   2,548 389
4,074   3,242 832
546   509 37
1,637   1,719 -82
3,399   2,807 592
458   460 -2
7,926   4,663 3,263
3,686   3,023 663
2,713   2,486 227
6,924   6,208 716
5,314   4,108 1,206
2,368   1,747 621
1,658   1,132 526
1,658   1,396 262
1,736   1,369 367
873   628 245
10,515   11,192 -677
399   475 -76
2,169   2,470 -301
2,756   2,842 -86
748   868 -120
6,735   4,013 2,722
3,788   1,241 2,547
2,270   1,634 636
1,095   661 434
5,151   4,417 734
4,619   4,077 542
10,124   10,175 -51
4,899   4,990 -91
4,984   5,019 -35
5,217   5,625 -408
10,613   12,502 -1,889
7,826   7,843 -17
15,594   16,352 -758
9,011   9,871 -860
5,130   4,671 459
2,848   3,480 -632
3,722   2,399 1,323
4,492   3,737 755
3,352   2,803 549
4,041   2,959 1,082
10,667   10,648 19
5,333   5,413 -80
4,000   4,217 -217
6,227   4,357 1,870
16,024   16,000 24
1,030   1,054 -24
5,162   5,167 -5
10,323   10,700 -377
3,751   2,654 1,097
8,433   9,858 -1,425
9,552   10,913 -1,361
2,185   1,802 383
1,574   1,090 484
787   662 125
      4,083
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       -250
b       4,281
c       6,389
d       -3,587
e       1,634
      -812
      966
      1,298
      1,664
      2,191
      2,909
      325
      -27
      -100
      -2,766
      -2,710
      411
      949
      7,220
      827
      207
      118
      -258
      228
      76
      885
      -150
      93
      3,486
      655
      690
      1,423
      -210
      155
      1,078
      -482
      334
      -13
      128
      25
      152
      748
      368
      1,612
      -98
      173
      436
      680
      249
      865
      350
      347
      364
      814
      -22
      674
      61
      -272
      551
      366
      329
      -69
      -376
      1,017
      484
      -53
      613
      -155
      589
      1,076
      1,302
      165
      1,352
      3
      389
      832
      37
      -82
      592
      -2
      3,263
      663
      227
      716
      1,206
      621
      526
      262
      367
      245
      -677
      -76
      -301
      -86
      -120
      2,722
      2,547
      636
      434
      734
      542
      -51
      -91
      -35
      -408
      -1,889
      -17
      -758
      -860
      459
      -632
      1,323
      755
      549
      1,082
      19
      -80
      -217
      1,870
      24
      -24
      -5
      -377
      1,097
      -1,425
      -1,361
      383
      484
      125
       
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 64,989
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 100,437 1,720,000 0.058394
2013 0 1,612,805 0.0
2012 12,691 1,465,056 0.008662
2011 59,598 1,455,748 0.04094
2010 112,013 1,407,727 0.07957
2
Total of line 1, column (d) .....................
20.187566
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
0.037513
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
1,668,945
5
Multiply line 4 by line 3......................
5
62,607
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
727
7
Add lines 5 and 6........................
7
63,334
8
Enter qualifying distributions from Part XII, line 4.............
8
93,891
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 1 727
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........................... 3 727
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- ..... 5 727
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 2,688
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 2,688
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 1,961
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet728 RefundedBullet 11 1,233
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)
    bulletNJ
    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 addressbullet  
    14
    The books are in care ofbulletTD BANK NA Telephone no.bullet (973) 425-8943

    Located atbullet1500 ROUTE 202BASKING RIDGENJ ZIP+4bullet07920
    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
     
     
    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
     
     
    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
    TD Bank NA TRUSTEE
    1     		24,187    
    1500 ROUTE 202
    BASKING RIDGE,NJ07920
    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
    1,627,692
    b
    Average of monthly cash balances.......................
    1b
    66,668
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    1,694,360
    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
    1,694,360
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    25,415
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    1,668,945
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    83,447
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    83,447
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    727
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    727
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    82,720
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    82,720
    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
    82,720
    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
    93,891
    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
    93,891
    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
    727
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    93,164
    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 82,720
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only....... 0
    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...... 499
    fTotal of lines 3a through e........ 499
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 93,891
    a Applied to 2014, but not more than line 2a 0
    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..... 82,720
    e Remaining amount distributed out of corpus 11,171
    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 11,670
    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 ..........     		0
    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 ......     		11,670
    10 Analysis of line 9:
    a Excess from 2011.... 0
    b Excess from 2012.... 0
    c Excess from 2013.... 0
    d Excess from 2014.... 499
    e Excess from 2015.... 11,171
    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
    GISELLE E BATISTA
    540 LIBERTY AVENUE 1
    JERSEY CITY,NJ07307     		NONE INDIVIDUAL SCHOLARSHIP 1,628
    GENEROSA C AUSTERO
    192 WEBSTER AVENUE
    JERSEY CITY,NJ07307     		NONE INDIVIDUAL SCHOLARSHIP 1,262
    MARJORIE BOYDEN-EDMONDS
    23-44 101 STREET
    EAST ELMHURST,NY11369     		NONE INDIVIDUAL SCHOLARSHIP 3,470
    MAUREEN CAPPIELLO
    445 POST AVENUE
    LYNDHURST,NJ07071     		NONE INDIVIDUAL SCHOLARSHIP 636
    JESSELLY DELACRUZ
    400 WOODCLIFF AVE APT 4
    NORTH BERGEN,NJ07047     		NONE INDIVIDUAL SCHOLARSHIP 3,600
    DIPAK C DESAI
    30 MARGARET COURT
    DUMONT,NJ07628     		NONE INDIVIDUAL SCHOLARSHIP 200
    KIMBERLY FIGUEROA
    1300 PALISADE AVE D 1
    UNION CITY,NJ07087     		NONE INDIVIDUAL SCHOLARSHIP 3,600
    ERIN MS FURDA
    57 BURNSIDE AVENUE
    STATEN ISLAND,NY10302     		NONE INDIVIDUAL SCHOLARSHIP 327
    KEITH GREENE
    85 PARKWAY DRIVE WEST
    EAST ORANGE,NJ07018     		NONE INDIVIDUAL SCHOLARSHIP 550
    RICHARD GUTIERREZ JR
    117 NORTH ST
    JERSEY CITY,NJ07307     		NONE INDIVIDUAL SCHOLARSHIP 1,889
    PETER JIMENEZ
    15 PALISADE AVE APT 221
    JERSEY CITY,NJ07306     		NONE INDIVIDUAL SCHOLARSHIP 2,246
    ANN P LOGAN
    17 GOLFVIEW DRIVE
    PRINCETON,NJ08540     		NONE INDIVIDUAL SCHOLARSHIP 972
    SHANNON R LYNCH
    9 REGENT ST APT 811
    JERSEY CITY,NJ07302     		NONE INDIVIDUAL SCHOLARSHIP 293
    BRIAN P MCDONOUGH
    134 JOHNSON LANE
    PARLIN,NJ08859     		NONE INDIVIDUAL SCHOLARSHIP 3,366
    LIZETT S ORELLONA-CADENA
    3613 PALISADE AVENUE
    UNION CITY,NJ07087     		NONE INDIVIDUAL SCHOLARSHIP 900
    BHARATBHUSHAN PATEL
    29 GLENVIEW RD
    NUTLEY,NJ07110     		NONE INDIVIDUAL SCHOLARSHIP 2,160
    FRANCESCO RACANATI
    100 NIELSON AVE
    OAKLAND,NJ07436     		NONE INDIVIDUAL SCHOLARSHIP 611
    DANIEL A RISSO
    209 WILLOW AVE APT 4A
    HOBOKEN,NJ07030     		NONE INDIVIDUAL SCHOLARSHIP 3,600
    TAMMY D RODRIGUEZ
    127-62ND STREET
    WEST NEW YORK,NJ07093     		NONE INDIVIDUAL SCHOLARSHIP 3,600
    NICOLE L ROSSO
    127 HUMPHREY AVENUE
    BAYONNE,NJ07002     		NONE INDIVIDUAL SCHOLARSHIP 4,338
    DECSY M SANCHEZ
    72 AVENUE A
    LODI,NJ07644     		NONE INDIVIDUAL SCHOLARSHIP 720
    ERICA L SORENSEN
    526 WASHINGTON ST
    HOBOKEN,NJ07030     		NONE INDIVIDUAL SCHOLARSHIP 2,038
    MARYELL S TEVES
    87 ADAMS ST
    ISELIN,NJ08830     		NONE INDIVIDUAL SCHOLARSHIP 982
    MARIATINE SYLVAIN
    119-29 224TH ST
    CAMBRIA HEIGHTS,NY11411     		NONE INDIVIDUAL SCHOLARSHIP 476
    EDUARDO TORRES
    286 1ST STREET
    JERSEY CITY,NJ07302     		NONE INDIVIDUAL SCHOLARSHIP 3,600
    KATHERINE VERAS
    3344 PARK AVENUE APT 5
    HOBOKEN,NJ07030     		NONE INDIVIDUAL SCHOLARSHIP 1,627
    DENISE GOLOMBEK
    249 RIDGEFIELD AVE
    BOGOTA,NJ07603     		NONE INDIVIDUAL SCHOLARSHIP 355
    LUCIA JOB
    5101 PARK AVENUE
    WEST NEW YORK,NJ07093     		NONE INDIVIDUAL SCHOLARSHIP 335
    SUSAN KELLY
    136 SOUTH STREET 7
    JERSEY CITY,NJ07307     		NONE INDIVIDUAL SCHOLARSHIP 140
    MALGORZATA KRZEWSKA
    14 ANDREW ST 1
    BLOOMFIELD,NJ07003     		NONE INDIVIDUAL SCHOLARSHIP 3,600
    MARIA RAMISCAL
    227 TONNELE AVENUE
    JERSEY CITY,NJ07306     		NONE INDIVIDUAL SCHOLARSHIP 610
    JENSEN A RICHERT
    294 CORRETA AVE
    ISELIN,NJ08830     		NONE INDIVIDUAL SCHOLARSHIP 305
    KARLA M UGARTE
    401 BERGENTINE AVENUE
    UNION CITY,NJ07087     		NONE INDIVIDUAL SCHOLARSHIP 660
    JULIO C VASQUEZ
    25 CHESTNUT AVENUE
    ROCHELLE PARK,NJ07662     		NONE INDIVIDUAL SCHOLARSHIP 332
    CARMELO MILAZZO
    2126 NEW YORK AVENUE
    UNION CITY,NJ07087     		NONE INDIVIDUAL SCHOLARSHIP 1,618
    ELENA DUMANCAS
    128 HAWTHORNE ST
    ROSELLE PARK,NJ07204     		NONE INDIVIDUAL SCHOLARSHIP 570
    NAILYN VELASQUEZ
    1225 76TH STREET
    NORTH BERGEN,NJ07047     		NONE INDIVIDUAL SCHOLARSHIP 1,535
    EMILY VILENCHIK
    43 PHILHOWER ROAD
    LEBANON,NJ08833     		NONE INDIVIDUAL SCHOLARSHIP 2,035
    DAVID S ABDUSSABUR
    403 CLINTON AVENUE
    NEWARK,NJ07108     		NONE INDIVIDUAL SCHOLARSHIP 2,544
    GRACE ESPIRITY
    746 ELM STREET
    KEARNY,NJ07032     		NONE INDIVIDUAL SCHOLARSHIP 100
    MARIA NINA LANTING
    23 LONG VALLEY ROAD
    LODI,NJ07694     		NONE INDIVIDUAL SCHOLARSHIP 412
    REBECCA LIN
    1105 GLEN ROAD
    FORT LEE,NJ07024     		NONE INDIVIDUAL SCHOLARSHIP 600
    CANDACE MORAY
    117 NORTH STREET
    JERSEY CITY,NJ07304     		NONE INDIVIDUAL SCHOLARSHIP 3,070
    JACQUELINE FOREMAN
    18 HAWTHORNE AVE
    GLENRIDGE,NJ07028     		NONE INDIVIDUAL SCHOLARSHIP 797
    DEMETRIA GOTIA
    386 STEGMAN PKWY
    JERSEY CITY,NJ07035     		NONE INDIVIDUAL SCHOLARSHIP 223
    SARAH E HALLER
    514 HUDSON ST
    HOBOKEN,NJ07030     		NONE INDIVIDUAL SCHOLARSHIP 3,600
    GRACE HOYOUN LEE
    1350 15TH ST APT 9R
    FORT LEE,NJ07024     		NONE INDIVIDUAL SCHOLARSHIP 489
    DOMINIQUE L MARATTA
    188 PARK ST
    RIDGEFIELD PARK,NJ07660     		NONE INDIVIDUAL SCHOLARSHIP 2,028
    SUSAN J MIZZI
    66 SOUTH FRANKLIN TURNPIKE
    RAMSEY,NJ07446     		NONE INDIVIDUAL SCHOLARSHIP 150
    CHRISTOPHER L PEREZ
    140 MAYHILL ST
    SADDLE BROOK,NJ07663     		NONE INDIVIDUAL SCHOLARSHIP 240
    DARLENE PIERRE-PIERRE
    3256 BIRCH HILL DR
    TANNERSVILLE,PA18372     		NONE INDIVIDUAL SCHOLARSHIP 3,100
    DANIELLE RAMIREZ
    3 SKYTOP GARDENS 22
    PARLIN,NJ08859     		NONE INDIVIDUAL SCHOLARSHIP 375
    HERACLES SAINT-VIL
    PO BOX 360432
    BROOKLYN,NY11236     		NONE INDIVIDUAL SCHOLARSHIP 436
    NANCY T TRUPPNER
    308 WILLOW AVE
    HOBOKEN,NJ07030     		NONE INDIVIDUAL SCHOLARSHIP 894
    CRAIG J COSTA
    285 ESSEX ST
    STIRLING,NJ07980     		NONE INDIVIDUAL SCHOLARSHIP 2,484
    STEVEN J BAY
    140 DUMONT AVE
    DUMONT,NJ07628     		NONE INDIVIDUAL SCHOLARSHIP 399
    ERIKA V COLBERT
    37 JACOBY ST
    MAPLEWOOD,NJ07040     		NONE INDIVIDUAL SCHOLARSHIP 2,127
    MARY C DELEON
    47 SALESKI AVE
    SAYREVILLE,NJ08872     		NONE INDIVIDUAL SCHOLARSHIP 225
    DEBORAH SCHWING
    5 CHURCH TOWERS
    HOBOKEN,NJ07030     		NONE INDIVIDUAL SCHOLARSHIP 295
    JAMES RAFAEL
    27 CLARKEN DR
    WEST ORANGE,NJ07052     		NONE INDIVIDUAL SCHOLARSHIP 295
    ANTHONY J CINA
    1200 GRAND ST 427
    HOBOKEN,NJ07030     		NONE INDIVIDUAL SCHOLARSHIP 1,052
    MAIRENI C GOMEZ
    300 WHITON ST 2
    JERSEY CITY,NJ07304     		NONE INDIVIDUAL SCHOLARSHIP 1,602
    NAZIA SHAH
    3312 HUDSON AVE
    UNION CITY,NJ07087     		NONE INDIVIDUAL SCHOLARSHIP 2,096
    FLORINE JONES
    245 MOUNTAIN AVENUE
    NORTH PLAINFIELD,NJ07060     		NONE INDIVIDUAL SCHOLARSHIP 819
    KRYSTLE CLAUDIO
    182 COLOMBIA AVE
    JERSEY CITY,NJ07307     		NONE INDIVIDUAL SCHOLARSHIP 2,653
    Total .................................bullet 3a 93,891
    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 34,897  
    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 64,989  
    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)..   99,886  
    13Total. Add line 12, columns (b), (d), and (e)..................
    1399,886
    (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 AccountingFeesSchedule
    Name:
    RAMSAYE HELENE MEDICAL TRUST 31H076015
    EIN:
    22-6333204
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 725 725    

    TY 2015 InvestmentsCorpBondsSchedule
    Name:
    RAMSAYE HELENE MEDICAL TRUST 31H076015
    EIN:
    22-6333204
    Name of Bond End of Year Book Value End of Year Fair Market Value
    CORPORATE BONDS 119,199 118,783
    MUTUAL FUNDS FIXED 115,359 113,992

    TY 2015 InvestmentsCorpStockSchedule
    Name:
    RAMSAYE HELENE MEDICAL TRUST 31H076015
    EIN:
    22-6333204
    Name of Stock End of Year Book Value End of Year Fair Market Value
    COMMON STOCKS 596,394 689,877
    MUTUAL FUNDS - EQUITIES 353,193 354,117

    TY 2015 InvestmentsGovtObligationsSch
    Name:
    RAMSAYE HELENE MEDICAL TRUST 31H076015
    EIN:
    22-6333204
    US Government Securities - End of Year Book Value:

    296,521
    US Government Securities - End of Year Fair Market Value:

    294,858
    State & Local Government Securities - End of Year Book Value:


     
    State & Local Government Securities - End of Year Fair Market Value:


     


    TY 2015 LegalFeesSchedule
    Name:
    RAMSAYE HELENE MEDICAL TRUST 31H076015
    EIN:
    22-6333204
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    NON-ALLOCABLE LEGAL FEES 1,794 1,794    


    TY 2015 OtherDecreasesSchedule
    Name:
    RAMSAYE HELENE MEDICAL TRUST 31H076015
    EIN:
    22-6333204
    Description Amount
    CASH / ACCRUAL ADJUSTMENT, ROUNDING 428
    RETURN OF CAPITAL ADJUSTMENT 475


    TY 2015 TaxesSchedule
    Name:
    RAMSAYE HELENE MEDICAL TRUST 31H076015
    EIN:
    22-6333204
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 146 146   0
    FEDERAL ESTIMATES - PRINCIPAL 1,484 0   0
    FOREIGN TAXES ON QUALIFIED FOR 306 306   0
    FOREIGN TAXES ON NONQUALIFIED 27 27   0