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
BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
 
Number and street (or P.O. box number if mail is not delivered to street address)17 PACIFIC STREET
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ST AUGUSTINE, FL32084
A Employer identification number

59-6137514
B Telephone number (see instructions)

(904) 819-1799
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$5,978,961
J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books
(b) Net investment
income
(c) Adjusted net
income
(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments 3 3  
4 Dividends and interest from securities... 171,742 171,742  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 76,936
b Gross sales price for all assets on line 6a 1,916,804
7 Capital gain net income (from Part IV, line 2)... 76,936
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)....... 11,460 11,460  
12 Total. Add lines 1 through 11........ 260,141 260,141  
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)....... 19,900 9,950   9,950
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... 2,958 1,047   71
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... 65,626 65,161   465
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 88,484 76,158   10,486
25 Contributions, gifts, grants paid....... 314,541 314,541
26 Total expenses and disbursements. Add lines 24 and 25 403,025 76,158   325,027
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -142,884
b Net investment income (if negative, enter -0-) 183,983
c Adjusted net income (if negative, enter -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......... 18,715 15,277 15,277
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)....... 2,380,268 Click to see attachment2,306,742 4,441,181
c Investments—corporate bonds (attach schedule)....... 1,593,149 Click to see attachment1,479,860 1,468,453
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 20,086 Click to see attachment36,031 36,031
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment16,067 Click to see attachment18,019 Click to see attachment18,019
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 4,028,285 3,855,929 5,978,961
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) Click to see attachment34,147 Click to see attachment4,675
23 Total liabilities (add lines 17 through 22)......... 34,147 4,675
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........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds 3,994,138 3,851,254
30 Total net assets or fund balances (see instructions)..... 3,994,138 3,851,254
31 Total liabilities and net assets/fund balances (see instructions). 4,028,285 3,855,929
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
3,994,138
2
Enter amount from Part I, line 27a .....................
2
-142,884
3
Other increases not included in line 2 (itemize) bullet
3
 
4
Add lines 1, 2, and 3 ..........................
4
3,851,254
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
3,851,254
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 10 SH-ACUITY BRANDS P 2015-08-14 2015-12-29
b 15 SH-ADOBE SYSTEMS P 2015-06-30 2015-12-09
c 1 SH-ADOBE SYSTEMS P 2015-06-29 2015-12-09
d 10 SH-ALEXION PHARM P 2015-03-05 2015-12-17
e 21 SH-ALIBABA GROUP P 2015-03-10 2015-09-04
16 SH-ALIBABA GROUP P 2014-10-15 2015-09-04
36 SH-ALIBABA GROUP P 2015-07-17 2015-09-04
45 SH-ALIBABA GROUP P 2015-02-09 2015-09-04
22 SH-ALIBABA GROUP P 2015-02-12 2015-09-04
25 SH-ALIBABA GROUP P 2014-10-09 2015-09-04
18 SH-ALIBABA GROUP P 2014-10-22 2015-09-04
15 SH-ALIBABA GROUP P 2014-12-08 2015-09-04
10 SH-ALIBABA GROUP P 2014-12-19 2015-09-04
8 SH-ALIBABA GROUP P 2014-12-04 2015-09-04
2 SH-AMAZON P 2014-10-10 2015-04-21
7 SH-AMAZON P 2014-06-04 2015-04-24
2 SH-AMAZON P 2014-12-23 2015-04-24
4 SH-AMAZON P 2015-09-04 2015-10-28
18 SH-APPLE P 2015-01-15 2015-11-20
4 SH-ARM HLDGS P 2014-10-22 2015-07-07
5 SH-ARM HLDGS P 2014-10-13 2015-07-07
8 SH-ARM HLDGS P 2014-10-14 2015-07-07
6 SH-ARM HLDGS P 2014-10-10 2015-07-07
43 SH-ARM HLDGS P 2014-10-22 2015-07-22
90 SH-BP AMOCO P 2015-01-06 2015-09-28
3 SH-BAIDU P 2014-10-10 2015-08-03
9 SH-BAIDU P 2015-02-23 2015-08-03
18 SH-BAIDU P 2015-07-01 2015-08-03
11 SH-BIOGEN P 2014-10-22 2015-02-03
1 SH-BIOGEN P 2014-10-10 2015-02-03
3 SH-BIOGEN P 2014-10-22 2015-03-20
3 SH-BIOGEN P 2014-04-24 2015-04-06
1142.49-BLACKROCK GLOBAL P 2015-02-09 2015-08-27
998.81-BLACKROCK GLOBAL P 2014-10-08 2015-08-27
10 SH-BRISTOL MYERS P 2015-03-13 2015-09-24
9 SH-BRISTOL MYERS P 2015-03-04 2015-09-24
4 SH-BRISTOL MYERS P 2015-03-04 2015-09-25
48 SH-CABOT OIL P 2015-01-06 2015-05-18
190 SH-CABOT OIL P 2015-01-06 2015-08-25
94 SH-CABOT OIL P 2015-01-06 2015-08-26
137 SH-CABOT OIL P 2015-01-06 2015-08-26
81 SH-CABOT OIL P 2015-01-06 2015-08-27
11 SH-CELGENE P 2015-04-22 2015-07-16
7 SH-CELGENE P 2015-07-01 2015-07-16
35 SH-CHEVRONTEXACO P 2015-01-06 2015-07-06
82 SH-CHEVRONTEXACO P 2015-01-06 2015-11-20
25 SH-COGNIZANT TECH P 2015-07-15 2015-10-09
32 SH-COMCAST P 2014-09-11 2015-08-14
1748.36 SH-EATON VANCE P 2014-10-08 2015-04-27
1 SH-FMC TECH P 2014-10-13 2015-06-29
35 SH-FMC TECH P 2014-12-30 2015-06-29
10 SH-FMC TECH P 2014-12-30 2015-07-01
43 SH-FMC TECH P 2015-03-10 2015-07-01
18 SH-FMC TECH P 2015-01-12 2015-07-01
20 SH-FMC TECH P 2015-07-13 2015-03-10
16 SH-FACEBOOK P 2015-07-01 2015-07-24
14 SH-FACEBOOK P 2015-08-31 2015-11-06
320 SH-FASTENAL P 2015-01-06 2015-03-04
6 SH-FASTENAL P 2015-01-06 2015-03-05
16 SH-HANDSBRANDS P 2014-05-07 2015-03-26
33 SH-HANDSBRANDS P 2014-05-05 2015-03-26
10 SH-ILLUMINA P 2014-11-17 2015-02-09
3 SH-ILLUMINA P 2014-10-27 2015-02-09
4 SH-ILLUMINA P 2014-11-17 2015-07-07
3 SH-ILLUMINA P 2015-09-01 2015-09-24
3 SH-ILLUMINA P 2015-08-12 2015-09-25
1 SH-ILLUMINA P 2015-09-01 2015-09-25
18 SH-INTL BUSINESS MACHINES P 2015-01-06 2015-01-15
40 SH-INTL BUSINESS MACHINES P 2015-01-06 2015-03-26
506 SH-ISHARES TR RUSSELL 1000 GROWTH P 2014-11-24 2015-01-06
350 SH-ISHARES TR IBOXX HIGH YIELD P 2014-12-26 2015-05-01
100 SH-ISHARES TR IBOXX HIGH YIELD P 2014-12-26 2015-07-31
143 SH-KINDER MORGAN P 2015-01-15 2015-11-12
62 SH-KINDER MORGAN P 2015-07-06 2015-11-12
4 SH-LINKEDIN P 2014-03-11 2015-02-11
6 SH-LINKEDIN P 2014-02-25 2015-02-11
11 SH-LINKEDIN P 2015-07-15 2015-10-16
5 SH-LINKEDIN P 2015-07-15 2015-01-26
108 SH-MEDTRONIC P 2015-01-15 2015-01-26
31 SH-METLIFE P 2014-05-06 2015-01-15
8 SH-MONSTER P 2015-05-07 2015-11-16
24 SH-MONSTER P 2015-05-07 2015-12-09
18 SH-NIKE P 2014-12-24 2015-10-09
10 SH-NIKE P 2014-12-05 2015-10-09
16 SH-NIKE P 2015-03-13 2015-10-09
5 SH-PHARMACYCLICS P 2014-03-11 2015-02-13
12 SH-PHARMACYCLICS P 2014-03-11 2015-02-23
21 SH-PHARMACYCLICS P 2014-05-28 2015-03-05
14 SH-PHARMACYCLICS P 2014-07-28 2015-03-05
6 SH-PHARMACYCLICS P 2014-10-13 2015-03-05
25 SH-PHARMACYCLICS P 2014-03-24 2015-03-05
2 SH-PHARMACYCLICS P 2014-10-10 2015-03-05
10 SH-PHARMACYCLICS P 2014-10-27 2015-03-05
5 SH-PHARMACYCLICS P 2014-10-22 2015-03-05
22 SH-PHILIP MORRIS P 2015-01-06 2015-03-26
2878.85 SH-PIMCO ALL ASSET P 2014-12-26 2015-02-09
1 SH-PRECISION CASTPARTS P 2014-10-10 2015-07-13
2 SH-PRICELINE P 2014-11-17 2015-07-13
1 SH-PRICELINE P 2014-10-22 2015-04-21
1 SH-PRICELINE P 2014-10-10 2015-05-11
2 SH-PRICELINE P 2014-12-19 2015-05-11
3511.85 SH-PRUDENTIAL SHORT TERM P 2014-02-15 2015-01-02
870.27 SH-PRUDENTIAL SHORT TERM P 2014-05-15 2015-01-02
874.11 SH-PRUDENTIAL SHORT TERM P 2014-02-06 2015-01-02
531.84 SH-PRUDENTIAL SHORT TERM P 2014-04-02 2015-01-02
3734.90 SH-PRUDENTIAL SHORT TERM P 2014-09-15 2015-07-06
1641.96 SH-PRUDENTIAL SHORT TERM P 2014-09-17 2015-07-30
689.88 SH-PRUDENTIAL SHORT TERM P 2014-09-15 2015-07-30
4381.07 SH-PRUDENTIAL SHORT TERM P 2014-09-17 2015-07-31
2329.75 SH-PRUDENTIAL SHORT TERM P 2015-02-10 2015-10-16
3960.40 SH-PRUDENTIAL SHORT TERM P 2015-03-03 2015-12-01
2118.65 SH-PRUDENTIAL SHORT TERM P 2015-02-10 2015-12-14
560.77 SH-PRUDENTIAL SHORT TERM P 2015-02-17 2015-12-14
488 SH-PRUDENTIAL SHORT TERM P 2015-03-03 2015-12-14
85 SH-ROCHE HLDG P 2014-11-07 2015-03-26
42 SH-ROCHE HLDG P 2014-11-07 2015-06-29
1011 SH-SPDR SER TR S&P DIVID P 2014-11-24 2015-01-06
15 SH-SALESFORCE P 2015-03-13 2015-04-30
15 SH-SERVICENOW P 2015-03-17 2015-12-11
17 SH-SERVICENOW P 2015-03-18 2015-12-11
19 SH-SERVICENOW P 2015-03-17 2015-12-29
26 SH-SPLUNK P 2014-12-26 2015-05-27
10 SH-SPLUNK P 2015-03-17 2015-05-28
1 SH-SPLUNK P 2014-12-26 2015-05-28
4 SH-TESLA P 2014-12-19 2015-06-12
7 SH-TESLA P 2015-08-07 2015-10-09
9 SH-TRACTOR SUPPLY P 2014-09-26 2015-02-09
2 SH-TRACTOR SUPPLY P 2014-09-26 2015-08-18
2 SH-TRACTOR SUPPLY P 2014-10-14 2015-10-01
6 SH-TRACTOR SUPPLY P 2014-10-10 2015-10-01
4 SH-TRACTOR SUPPLY P 2014-10-13 2015-10-01
16 SH-TWITTER P 2015-02-24 2015-04-21
28 SH-TWITTER P 2015-02-24 2015-04-27
7 SH-TWITTER P 2015-02-24 2015-06-25
47 SH-TWITTER P 2015-01-06 2015-06-25
328 SH-TWITTER P 2015-01-06 2015-06-26
69 SH-UNITED TECH P 2014-12-11 2015-11-20
51 SH-VERIZON P 2015-01-06 2015-08-14
8 SH-VISA P 2014-10-10 2015-05-01
8 SH-VISA P 2014-07-28 2015-05-01
46 SH-VISA P 2015-06-26 2015-09-16
1 SH-VMWARE P 2014-10-10 2015-08-26
21 SH-VMWARE P 2014-10-22 2015-08-26
23 SH-WALMART P 2014-11-05 2015-09-28
48 SH-WALMART P 2015-01-15 2015-09-28
44 SH-MEDTRONIC P 2015-03-26 2015-11-12
31 SH-MEDTRONIC P 2015-01-26 2015-11-12
28 SH-MICHAEL KORS P 2014-08-21 2015-06-08
5 SH-MICHAEL KORS P 2014-10-22 2015-06-08
3 SH-MICHAEL KORS P 2014-10-10 2015-06-08
2 SH-MICHAEL KORS P 2014-10-13 2015-06-08
14 SH-MICHAEL KORS P 2015-03-13 2015-06-08
800 SH-ETRACS ALERIAN P 2015-01-05 2015-09-08
187 SH-ABBVIE P 2013-07-29 2015-02-04
2 SH-AMAZON P 2014-03-26 2015-04-21
3 SH-AMAZON P 2014-04-11 2015-04-24
5 SH-AMAZON P 2014-06-04 2015-07-27
44 SH-AMERICAN EXPRESS P 2013-02-25 2015-03-25
15 SH-AMERICAN EXPRESS P 2013-02-26 2015-03-25
26 SH-AMERICAN EXPRESS P 2013-02-28 2015-03-25
42 SH-AMGEN P 2013-07-29 2015-01-15
13 SH-AMGEN P 2014-01-14 2015-01-15
85 SH-AMGEN P 2013-07-29 2015-06-29
23 SH-ARM HLDGS P 2014-02-05 2015-02-11
12 SH-ARM HLDGS P 2013-10-28 2015-02-11
2 SH-ARM HLDGS P 2013-11-01 2015-02-11
7 SH-ARM HLDGS P 2013-10-25 2015-02-11
15 SH-ARM HLDGS P 2014-02-05 2015-04-30
10 SH-ARM HLDGS P 2013-09-09 2015-05-11
9 SH-ARM HLDGS P 2014-02-05 2015-05-11
3 SH-ARM HLDGS P 2013-07-22 2015-05-12
16 SH-ARM HLDGS P 2013-09-09 2015-05-12
12 SH-ARM HLDGS P 2013-07-22 2015-05-18
24 SH-ARM HLDGS P 2013-07-22 2015-05-19
16 SH-ARM HLDGS P 2013-07-19 2015-05-19
25 SH-ARM HLDGS P 2013-07-19 2015-06-29
31 SH-ARM HLDGS P 2013-07-19 2015-07-01
23 SH-ARM HLDGS P 2013-07-19 2015-07-07
24 SH-ARM HLDGS P 2013-07-29 2015-07-22
14 SH-ARM HLDGS P 2013-07-26 2015-07-22
2384.21 SH-BLACKROCK GLOBAL P 2014-03-14 2015-08-27
5.83 SH-BLACKROCK GLOBAL P 2014-10-08 2015-12-11
37 SH-CDKL GLOBAL P 2013-07-29 2015-01-15
8 SH-CELGENE P 2011-02-10 2015-04-06
22 SH-CHUBB P 2013-07-29 2015-11-12
8 SH-COGNIZANT TECH P 2011-08-22 2015-04-06
16 SH-COGNIZANT TECH P 2013-05-15 2015-04-06
10 SH-COGNIZANT TECH P 2011-08-23 2015-04-06
112 SH-CONOCOPHILLIPS P 2013-09-06 2015-01-15
149 SH-DUPONT P 2013-07-29 2015-06-29
43 SH-DUKE ENERGY P 2013-07-29 2015-03-25
178 SH-EMC CORP P 2013-07-29 2015-06-29
132 SH-EMC CORP P 2014-01-14 2015-06-29
2 SH-FMC TECH P 2012-07-05 2015-07-01
1 SH-FACEBOOK P 2014-05-28 2015-07-24
13 SH-FACEBOOK P 2014-04-14 2015-07-24
11 SH-HALYARD HEALTH P 2013-07-29 2015-01-15
3 SH-HANESBRANDS INC P 2014-05-05 2015-08-05
160 SH-HANESBRANDS INC P 2014-05-06 2015-08-05
10 SH-HOME DEPOT P 2011-12-20 2015-03-26
4 SH-HOME DEPOT P 2012-06-25 2015-03-26
8 SH-HOME DEPOT P 2013-07-02 2015-03-26
10 SH-ILLUMINA P 2014-02-10 2015-07-07
153 SH-INTEL CORP P 2013-07-29 2015-11-20
250 SH-ISHARES TR DOW JONES SELECT P 2014-07-25 2015-11-06
200 SH-ISHARES TR IBOXX HIGH YIELD P 2012-07-23 2015-05-01
200 SH-ISHARES TR IBOXX HIGH YIELD P 2012-05-21 2015-12-28
52 SH-KLA TENCOR P 2013-07-29 2015-02-04
50 SH-KLA TENCOR P 2013-07-29 2015-02-05
8 SH-LINKEDIN P 2014-03-11 2015-03-24
3 SH-LINKEDIN P 2014-03-11 2015-03-24
1 SH-LINKEDIN P 2014-01-29 2015-03-25
1 SH-LINKEDIN P 2014-03-20 2015-11-02
1 SH-LINKEDIN P 2014-01-29 2015-11-02
37 SH-MACYS P 2013-07-29 2015-11-20
86 SH-MACYS P 2013-08-07 2015-11-20
37 SH-MCDONALDS P 2013-07-29 2015-03-26
69 SH-METLIFE P 2013-07-29 2015-01-15
31 SH-MONSANTO P 2013-01-04 2015-08-27
35 SH-MONSANTO P 2013-01-07 2015-08-27
25 SH-MONSANTO P 2013-09-09 2015-08-27
5 SH-MONSANTO P 2013-02-19 2015-08-27
11 SH-MONSANTO P 2013-02-15 2015-08-27
1 SH-MONSANTO P 2013-01-25 2015-08-27
4 SH-PHARMACYCLICS P 2014-01-30 2015-02-12
2 SH-PHARMACYCLICS P 2014-01-30 2015-02-13
1 SH-PHARMACYCLICS P 2014-01-14 2015-02-23
1 SH-PHARMACYCLICS P 2013-12-31 2015-02-23
32 SH-PHARMACYCLICS P 2014-01-14 2015-02-27
3 SH-PHARMACYCLICS P 2014-01-31 2015-02-27
1 SH-PHARMACYCLICS P 2014-01-31 2015-03-05
107 SH-PFIZER P 2014-01-14 2015-02-04
38 SH-PFIZER P 2013-07-29 2015-02-04
2272.73 SH-PIMCO FDS PAC P 2012-06-04 2015-11-06
3136.20 SH-PRUDENTIAL SHORT TERM P 2014-04-02 2015-06-26
733.37 SH-PRUDENTIAL SHORT TERM P 2014-04-02 2015-07-06
17 SH-RAYTHEON P 2014-01-14 2015-08-14
32 SH-RAYTHEON P 2013-07-29 2015-08-14
75 SH-RAYTHEON P 2013-07-29 2015-08-17
11 SH-RAYTHEON P 2013-07-29 2015-08-18
242 SH-ROCHE HLDG P 2014-02-11 2015-06-29
112 SH-ROYAL DUTCH P 2013-07-29 2015-09-28
13 SH-SALESFORCE P 2013-06-19 2015-04-30
8 SH-SALESFORCE P 2014-04-15 2015-04-30
21 SH-TRACTOR SUPPLY P 2014-07-18 2015-08-18
10 SH-TRACTOR SUPPLY P 2014-07-17 2015-08-19
3 SH-TRACTOR SUPPLY P 2014-07-18 2015-08-19
43 SH-TRACTOR SUPPLY P 2014-07-14 2015-09-04
4 SH-TRACTOR SUPPLY P 2014-07-17 2015-09-04
30 SH-TRACTOR SUPPLY P 2014-07-17 2015-09-17
31 SH-TRACTOR SUPPLY P 2014-07-17 2015-09-30
14 SH-TRACTOR SUPPLY P 2014-09-25 2015-10-01
5 SH-TRACTOR SUPPLY P 2014-07-17 2015-10-01
90 SH-US BANCORP P 2013-07-29 2015-11-20
35 SH-UNITED TECH P 2013-07-29 2015-11-20
18 SH-VISA INC P 2011-06-30 2015-05-01
8 SH-VMWARE P 2013-05-14 2015-08-26
4 SH-VMWARE P 2013-11-14 2015-08-31
46 SH-VMWARE P 2013-05-14 2015-08-31
16 SH-VMWARE P 2013-11-14 2015-09-09
34 SH-VMWARE P 2013-06-14 2015-09-09
16 SH-VMWARE P 2013-06-13 2015-09-09
4 SH-VMWARE P 2013-07-18 2015-09-09
6 SH-VMWARE P 2013-06-13 2015-09-10
7 SH-WALMART P 2014-11-05 2015-11-20
35 SH-WALMART P 2014-08-27 2015-11-20
23 SH-MICHAEL KORS P 2012-03-15 2015-06-08
122 SH-MICHAEL KORS P 2012-03-23 2015-06-08
4 SH-MICHAEL KORS P 2012-03-15 2015-06-09
4 SH-AMAZON P 2008-08-01 2015-07-27
2 SH-AMAZON P 2008-08-01 2015-10-28
4 SH-AMAZON P 2008-08-01 2015-12-09
2 SH-AMAZON P 2008-08-01 2015-12-16
11 SH-BAIDU P 2010-07-19 2015-08-03
28 SH-BAIDU P 2010-07-19 2015-08-03
34 SH-BAIDU P 2010-07-19 2015-08-03
50000 SH-BERKSHIRE HATHAWAY P 2011-06-02 2015-02-11
50000 SH-BOEING CO P 2011-01-11 2015-02-15
1 SH-CELGENE P 2010-08-31 2015-04-06
24 SH-CELGENE P 2009-01-28 2015-04-06
2 SH-CELGENE P 2009-10-26 2015-04-06
1 SH-CELGENE P 2010-07-02 2015-07-16
5 SH-CELGENE P 2010-08-31 2015-07-16
50000 SH-COCA COLA P 2012-11-05 2015-07-31
4 SH-COGNIZANT TECH P 2010-05-11 2015-04-06
50000 SH-DUPONT P 2011-01-03 2015-01-15
62 SH-FMC TECH P 2008-12-01 2015-07-13
20 SH-FMC TECH P 2008-11-06 2015-07-13
13 SH-FMC TECH P 2010-05-24 2015-07-13
66 SH-FMC TECH P 2008-11-25 2015-07-14
26 SH-FMC TECH P 2008-12-01 2015-07-14
2000 SH-ISHARES COMEX GOLD P 2013-07-23 2015-01-30
500 SH-ISHARES COMEX GOLD P 2013-07-23 2015-08-07
1250 SH-ISHARES COMEX GOLD P 2013-07-23 2015-10-23
1250 SH-ISHARES COMEX GOLD P 2013-10-22 2015-10-23
3350 SH-ISHARES COMEX GOLD P 2013-10-22 2015-11-13
1650 SH-ISHARES COMEX GOLD P 2014-07-25 2015-11-13
500 SH-ISHARES TR IBOXX HIGH YIELD P 2011-06-20 2015-08-05
250 SH-ISHARES TR IBOXX HIGH YIELD P 2011-06-20 2015-12-28
500 SH-JP MORGAN ALERIAN P 2011-10-12 2015-01-05
500 SH-JP MORGAN ALERIAN P 2011-10-21 2015-01-05
1000 SH-JP MORGAN ALERIAN P 2011-06-20 2015-01-05
335.1 SH-JANUS INVT FUND P 2008-12-19 2015-05-01
843.27 SH-PIMCO FDS PAC P 2010-12-28 2015-07-31
4045.31 SH-PIMCO FDS PAC P 2011-06-20 2015-08-07
1236.15 SH-PIMCO FDS PAC P 2011-10-12 2015-11-06
5 SH-PRECISION CASTPARTS P 2010-11-10 2015-07-13
24 SH-PRECISION CASTPARTS P 2010-09-22 2015-07-13
11 SH-PRECISION CASTPARTS P 2010-09-22 2015-07-13
4 SH-PRECISION CASTPARTS P 2010-11-23 2015-07-13
3 SH-PRECISION CASTPARTS P 2010-09-22 2015-07-14
1 SH-PRICELINE P 2009-07-27 2015-05-27
50000 SH-PROCTER & GAMBLE P 2011-01-11 2015-02-15
48 SH-SALESFORCE P 2009-12-31 2015-04-30
17 SH-SALESFORCE P 2009-12-30 2015-05-05
56 SH-SALESFORCE P 2009-12-31 2015-05-05
39 SH-SALESFORCE P 2009-12-30 2015-05-06
24 SH-SALESFORCE P 2009-12-28 2015-05-06
80 SH-SALESFORCE P 2010-02-11 2015-05-06
50000 SH-US BANCORP P 2011-05-12 2015-03-04
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-01-31
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-02-28
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-03-31
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-04-30
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-05-31
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-06-30
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-01-31
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-01-31
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-02-28
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-02-28
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-03-31
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-03-31
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-04-30
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-04-30
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-05-31
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-05-31
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-06-30
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-06-30
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-07-31
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-07-31
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-07-31
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-08-31
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-08-31
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-08-31
1 SH-ISHARES COMEX GOLD P 2013-07-23 2015-09-30
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-09-30
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-09-30
1 SH-ISHARES COMEX GOLD P 2013-10-22 2015-10-31
1 SH-ISHARES COMEX GOLD P 2014-07-25 2015-10-31
CAPITAL GAIN DISTRIBUTIONS P 2014-01-01 2015-12-31
(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 2,349 0 2,097 252
b 1,361 0 1,228 133
c 91 0 82 9
d 1,863 0 1,852 11
e 1,347 0 1,743 -396
1,026 0 1,364 -338
2,309 0 2,982 -673
2,886 0 3,872 -986
1,411 0 1,924 -513
1,603 0 2,232 -629
1,155 0 1,670 -515
962 0 1,578 -616
641 0 1,088 -447
513 0 874 -361
787 0 633 154
3,136 0 2,142 994
896 0 613 283
2,459 0 1,994 465
2,144 0 1,939 205
193 0 159 34
242 0 199 43
387 0 326 61
290 0 244 46
1,941 0 1,712 229
2,667 0 3,217 -550
506 0 619 -113
1,519 0 1,858 -339
3,038 0 3,559 -521
4,290 0 3,308 982
390 0 322 68
1,393 0 902 491
1,247 0 890 357
13,459 0 13,584 -125
11,766 0 12,056 -290
619 0 619 0
557 0 557 0
249 0 249 0
1,688 0 1,343 345
4,122 0 5,316 -1,194
2,001 0 2,630 -629
2,959 0 3,833 -874
1,760 0 2,266 -506
1,481 0 1,275 206
942 0 825 117
3,324 0 3,738 -414
7,337 0 8,759 -1,422
1,665 0 1,529 136
1,873 0 1,821 52
26,155 0 27,222 -1,067
41 0 51 -10
1,425 0 1,670 -245
398 0 477 -79
1,710 0 1,642 68
716 0 742 -26
746 0 763 -17
1,543 0 1,390 153
1,495 0 1,261 234
12,725 0 14,618 -1,893
238 0 274 -36
534 0 328 206
1,102 0 676 426
1,936 0 1,828 108
581 0 572 9
882 0 731 151
565 0 565 0
568 0 568 0
189 0 189 0
2,789 0 2,813 -24
6,421 0 6,250 171
47,028 0 48,853 -1,825
31,744 0 31,641 103
8,793 0 9,040 -247
3,382 0 5,859 -2,477
1,466 0 2,333 -867
1,079 0 824 255
1,618 0 1,258 360
2,167 0 2,424 -257
1,212 0 1,102 110
8,311 0 7,752 559
1,500 0 1,577 -77
1,165 0 1,139 26
3,639 0 3,416 223
2,239 0 1,746 493
1,244 0 992 252
1,990 0 1,552 438
819 0 681 138
2,274 0 1,634 640
5,339 0 1,862 3,477
3,559 0 1,485 2,074
1,525 0 641 884
6,356 0 2,859 3,497
508 0 216 292
2,542 0 1,248 1,294
1,271 0 577 694
1,683 0 1,793 -110
26,543 0 27,263 -720
193 0 226 -33
2,462 0 2,312 150
1,195 0 1,132 63
1,186 0 1,088 98
2,371 0 2,222 149
39,438 0 40,105 -667
9,773 0 9,930 -157
9,816 0 9,965 -149
5,973 0 6,042 -69
41,794 0 42,205 -411
18,308 0 18,538 -230
7,692 0 7,796 -104
48,893 0 49,462 -569
26,000 0 26,186 -186
44,000 0 44,515 -515
23,411 0 23,814 -403
6,196 0 6,297 -101
5,392 0 5,485 -93
2,907 0 3,117 -210
1,488 0 1,540 -52
77,852 0 81,580 -3,728
1,078 0 976 102
1,271 0 1,196 75
1,441 0 1,357 84
1,668 0 1,515 153
1,800 0 1,649 151
692 0 621 71
69 0 63 6
1,004 0 867 137
1,548 0 1,692 -144
741 0 554 187
188 0 123 65
169 0 116 53
506 0 346 160
337 0 232 105
820 0 781 39
1,468 0 1,367 101
246 0 342 -96
1,653 0 1,742 -89
11,441 0 12,152 -711
6,802 0 7,881 -1,079
2,425 0 2,375 50
527 0 415 112
527 0 427 100
3,230 0 3,155 75
77 0 92 -15
1,606 0 1,767 -161
1,465 0 1,788 -323
3,057 0 4,186 -1,129
3,292 0 3,365 -73
2,319 0 2,363 -44
1,355 0 2,295 -940
242 0 380 -138
145 0 223 -78
97 0 147 -50
678 0 921 -243
25,233 0 32,208 -6,975
10,694 0 8,394 2,300
787 0 697 90
1,344 0 934 410
2,665 0 1,530 1,135
3,531 0 2,743 788
1,204 0 929 275
2,087 0 1,618 469
6,432 0 4,589 1,843
1,991 0 1,530 461
13,199 0 9,288 3,911
1,151 0 1,027 124
600 0 572 28
100 0 92 8
350 0 334 16
764 0 670 94
532 0 431 101
479 0 402 77
158 0 126 32
843 0 690 153
626 0 502 124
1,257 0 1,004 253
838 0 660 178
1,228 0 1,031 197
1,523 0 1,278 245
1,112 0 948 164
1,084 0 953 131
632 0 551 81
28,086 0 27,967 119
70 0 0 70
1,554 0 1,012 542
906 0 206 700
2,827 0 1,914 913
500 0 229 271
1,000 0 506 494
625 0 284 341
6,989 0 7,683 -694
9,557 0 8,536 1,021
3,232 0 3,070 162
4,647 0 4,681 -34
3,446 0 3,388 58
80 0 83 -3
96 0 63 33
1,254 0 758 496
505 0 358 147
87 0 62 25
4,627 0 3,268 1,359
1,129 0 417 712
452 0 206 246
904 0 619 285
2,205 0 1,612 593
5,329 0 3,547 1,782
19,016 0 18,857 159
18,140 0 18,156 -16
16,013 0 17,619 -1,606
3,293 0 2,794 499
3,152 0 2,687 465
2,116 0 1,647 469
793 0 616 177
264 0 206 58
242 0 205 37
242 0 205 37
1,428 0 1,790 -362
3,319 0 4,125 -806
3,592 0 3,610 -18
3,340 0 3,352 -12
3,046 0 2,986 60
3,439 0 3,353 86
2,456 0 2,542 -86
491 0 513 -22
1,081 0 1,134 -53
98 0 103 -5
652 0 547 105
327 0 274 53
189 0 133 56
189 0 136 53
6,912 0 4,269 2,643
648 0 400 248
254 0 133 121
3,432 0 3,319 113
1,219 0 1,130 89
24,341 0 26,500 -2,159
35,000 0 35,627 -627
8,206 0 8,331 -125
1,870 0 1,548 322
3,520 0 2,272 1,248
8,233 0 5,324 2,909
1,207 0 781 426
8,572 0 8,652 -80
5,170 0 7,590 -2,420
934 0 497 437
575 0 430 145
1,971 0 1,292 679
929 0 614 315
279 0 185 94
3,614 0 2,638 976
333 0 245 88
2,614 0 1,840 774
2,615 0 1,902 713
1,181 0 851 330
422 0 307 115
3,673 0 3,364 309
3,451 0 3,673 -222
1,186 0 440 746
612 0 621 -9
318 0 310 8
3,658 0 3,570 88
1,266 0 1,238 28
2,690 0 2,414 276
1,266 0 1,130 136
317 0 289 28
471 0 424 47
425 0 544 -119
2,124 0 2,653 -529
1,113 0 1,083 30
5,903 0 5,797 106
192 0 189 3
2,132 0 302 1,830
1,230 0 151 1,079
2,702 0 302 2,400
1,327 0 151 1,176
1,856 0 787 1,069
4,725 0 2,044 2,681
5,738 0 2,417 3,321
50,000 0 51,804 -1,804
50,000 0 51,842 -1,842
113 0 26 87
2,717 0 625 2,092
226 0 53 173
135 0 26 109
673 0 129 544
50,134 0 50,685 -551
250 0 103 147
50,000 0 51,431 -1,431
2,312 0 783 1,529
746 0 351 395
485 0 376 109
2,485 0 819 1,666
979 0 328 651
24,763 0 25,813 -1,050
5,274 0 6,445 -1,171
14,011 0 16,106 -2,095
14,011 0 16,085 -2,074
34,940 0 43,098 -8,158
17,209 0 20,822 -3,613
43,802 0 44,746 -944
20,017 0 22,373 -2,356
22,688 0 17,573 5,115
22,688 0 18,283 4,405
45,376 0 35,480 9,896
31,000 0 10,727 20,273
9,537 0 10,524 -987
45,267 0 50,000 -4,733
13,239 0 14,500 -1,261
966 0 686 280
4,639 0 3,103 1,536
2,126 0 1,422 704
773 0 539 234
579 0 388 191
1,198 0 123 1,075
50,000 0 52,081 -2,081
3,449 0 887 2,562
1,220 0 313 907
4,017 0 1,035 2,982
2,878 0 719 2,159
1,771 0 438 1,333
5,903 0 1,317 4,586
50,000 0 51,245 -1,245
4 0 4 0
4 0 4 0
4 0 4 0
3 0 3 0
4 0 5 -1
4 0 5 -1
9 0 10 -1
12 0 12 0
4 0 5 -1
11 0 12 -1
4 0 5 -1
11 0 12 -1
4 0 5 -1
11 0 12 -1
4 0 5 -1
11 0 12 -1
4 0 5 -1
11 0 12 -1
11 0 13 -2
4 0 5 -1
4 0 5 -1
11 0 12 -1
3 0 3 0
4 0 4 0
3 0 4 -1
10 0 12 -2
4 0 5 -1
8 0 9 -1
4 0 5 -1
21,205 0 0 21,205
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 0 0 0 252
b 0 0 0 133
c 0 0 0 9
d 0 0 0 11
e 0 0 0 -396
0 0 0 -338
0 0 0 -673
0 0 0 -986
0 0 0 -513
0 0 0 -629
0 0 0 -515
0 0 0 -616
0 0 0 -447
0 0 0 -361
0 0 0 154
0 0 0 994
0 0 0 283
0 0 0 465
0 0 0 205
0 0 0 34
0 0 0 43
0 0 0 61
0 0 0 46
0 0 0 229
0 0 0 -550
0 0 0 -113
0 0 0 -339
0 0 0 -521
0 0 0 982
0 0 0 68
0 0 0 491
0 0 0 357
0 0 0 -125
0 0 0 -290
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 345
0 0 0 -1,194
0 0 0 -629
0 0 0 -874
0 0 0 -506
0 0 0 206
0 0 0 117
0 0 0 -414
0 0 0 -1,422
0 0 0 136
0 0 0 52
0 0 0 -1,067
0 0 0 -10
0 0 0 -245
0 0 0 -79
0 0 0 68
0 0 0 -26
0 0 0 -17
0 0 0 153
0 0 0 234
0 0 0 -1,893
0 0 0 -36
0 0 0 206
0 0 0 426
0 0 0 108
0 0 0 9
0 0 0 151
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 -24
0 0 0 171
0 0 0 -1,825
0 0 0 103
0 0 0 -247
0 0 0 -2,477
0 0 0 -867
0 0 0 255
0 0 0 360
0 0 0 -257
0 0 0 110
0 0 0 559
0 0 0 -77
0 0 0 26
0 0 0 223
0 0 0 493
0 0 0 252
0 0 0 438
0 0 0 138
0 0 0 640
0 0 0 3,477
0 0 0 2,074
0 0 0 884
0 0 0 3,497
0 0 0 292
0 0 0 1,294
0 0 0 694
0 0 0 -110
0 0 0 -720
0 0 0 -33
0 0 0 150
0 0 0 63
0 0 0 98
0 0 0 149
0 0 0 -667
0 0 0 -157
0 0 0 -149
0 0 0 -69
0 0 0 -411
0 0 0 -230
0 0 0 -104
0 0 0 -569
0 0 0 -186
0 0 0 -515
0 0 0 -403
0 0 0 -101
0 0 0 -93
0 0 0 -210
0 0 0 -52
0 0 0 -3,728
0 0 0 102
0 0 0 75
0 0 0 84
0 0 0 153
0 0 0 151
0 0 0 71
0 0 0 6
0 0 0 137
0 0 0 -144
0 0 0 187
0 0 0 65
0 0 0 53
0 0 0 160
0 0 0 105
0 0 0 39
0 0 0 101
0 0 0 -96
0 0 0 -89
0 0 0 -711
0 0 0 -1,079
0 0 0 50
0 0 0 112
0 0 0 100
0 0 0 75
0 0 0 -15
0 0 0 -161
0 0 0 -323
0 0 0 -1,129
0 0 0 -73
0 0 0 -44
0 0 0 -940
0 0 0 -138
0 0 0 -78
0 0 0 -50
0 0 0 -243
0 0 0 -6,975
0 0 0 2,300
0 0 0 90
0 0 0 410
0 0 0 1,135
0 0 0 788
0 0 0 275
0 0 0 469
0 0 0 1,843
0 0 0 461
0 0 0 3,911
0 0 0 124
0 0 0 28
0 0 0 8
0 0 0 16
0 0 0 94
0 0 0 101
0 0 0 77
0 0 0 32
0 0 0 153
0 0 0 124
0 0 0 253
0 0 0 178
0 0 0 197
0 0 0 245
0 0 0 164
0 0 0 131
0 0 0 81
0 0 0 119
0 0 0 70
0 0 0 542
0 0 0 700
0 0 0 913
0 0 0 271
0 0 0 494
0 0 0 341
0 0 0 -694
0 0 0 1,021
0 0 0 162
0 0 0 -34
0 0 0 58
0 0 0 -3
0 0 0 33
0 0 0 496
0 0 0 147
0 0 0 25
0 0 0 1,359
0 0 0 712
0 0 0 246
0 0 0 285
0 0 0 593
0 0 0 1,782
0 0 0 159
0 0 0 -16
0 0 0 -1,606
0 0 0 499
0 0 0 465
0 0 0 469
0 0 0 177
0 0 0 58
0 0 0 37
0 0 0 37
0 0 0 -362
0 0 0 -806
0 0 0 -18
0 0 0 -12
0 0 0 60
0 0 0 86
0 0 0 -86
0 0 0 -22
0 0 0 -53
0 0 0 -5
0 0 0 105
0 0 0 53
0 0 0 56
0 0 0 53
0 0 0 2,643
0 0 0 248
0 0 0 121
0 0 0 113
0 0 0 89
0 0 0 -2,159
0 0 0 -627
0 0 0 -125
0 0 0 322
0 0 0 1,248
0 0 0 2,909
0 0 0 426
0 0 0 -80
0 0 0 -2,420
0 0 0 437
0 0 0 145
0 0 0 679
0 0 0 315
0 0 0 94
0 0 0 976
0 0 0 88
0 0 0 774
0 0 0 713
0 0 0 330
0 0 0 115
0 0 0 309
0 0 0 -222
0 0 0 746
0 0 0 -9
0 0 0 8
0 0 0 88
0 0 0 28
0 0 0 276
0 0 0 136
0 0 0 28
0 0 0 47
0 0 0 -119
0 0 0 -529
0 0 0 30
0 0 0 106
0 0 0 3
0 0 0 1,830
0 0 0 1,079
0 0 0 2,400
0 0 0 1,176
0 0 0 1,069
0 0 0 2,681
0 0 0 3,321
0 0 0 -1,804
0 0 0 -1,842
0 0 0 87
0 0 0 2,092
0 0 0 173
0 0 0 109
0 0 0 544
0 0 0 -551
0 0 0 147
0 0 0 -1,431
0 0 0 1,529
0 0 0 395
0 0 0 109
0 0 0 1,666
0 0 0 651
0 0 0 -1,050
0 0 0 -1,171
0 0 0 -2,095
0 0 0 -2,074
0 0 0 -8,158
0 0 0 -3,613
0 0 0 -944
0 0 0 -2,356
0 0 0 5,115
0 0 0 4,405
0 0 0 9,896
0 0 0 20,273
0 0 0 -987
0 0 0 -4,733
0 0 0 -1,261
0 0 0 280
0 0 0 1,536
0 0 0 704
0 0 0 234
0 0 0 191
0 0 0 1,075
0 0 0 -2,081
0 0 0 2,562
0 0 0 907
0 0 0 2,982
0 0 0 2,159
0 0 0 1,333
0 0 0 4,586
0 0 0 -1,245
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 0
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 -2
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 0
0 0 0 0
0 0 0 -1
0 0 0 -2
0 0 0 -1
0 0 0 -1
0 0 0 -1
0 0 0 21,205
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 76,936
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 -17,101
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 344,127 6,746,537 0.051008
2013 326,826 6,605,375 0.049479
2012 328,034 6,346,236 0.051690
2011 309,684 6,322,050 0.048985
2010 300,329 5,877,696 0.051096
2
Total of line 1, column (d) .....................
20.252258
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
0.050452
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
6,109,342
5
Multiply line 4 by line 3......................
5
308,229
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
1,840
7
Add lines 5 and 6........................
7
310,069
8
Enter qualifying distributions from Part XII, line 4.............
8
325,027
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form 990-PF (2015)
Form 990-PF (2015)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 1,840
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 1,840
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 1,840
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 4,980
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.............. Part VI Line 7 - Original Return Overpayment: -4980 7 4,980
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
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 3,140
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet3,140 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
 
 
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)
    bulletFL
    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 ofbulletBRADLEY K DAVIS CPA-DAVIS & DAVIS-CPAs PA Telephone no.bullet (904) 819-1799

    Located atbullet17 PACIFIC STSUITE AST AUGUSTINEFL ZIP+4bullet32084
    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
     
     
    ........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
     
     
    .........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
    REUBEN J PLANT VPres-Trustee
    0.50
    0 0 0
    84 Village Del Lago Circle
    St Augustine,FL32080
    DARRELL POLI Pres-Trustee
    1.00
    0 0 0
    150 Riberia Street
    St Augustine,FL32084
    BRADLEY K DAVIS Sec/Treas-Trustee
    168.00
    19,900 0 0
    34 Bay View Drive
    St Augustine,FL32084
    JOSEPH BOLES JR-19 RIBERIA ST Trustee
    0.40
    0 0 0
    19 Riberia Street
    St Augustine,FL32084
    OTIS MASON Trustee
    0.40
    0 0 0
    13 Christopher St
    St Augustine,FL32084
    MICHAEL SANDERS Trustee
    0.40
    0 0 0
    2464 Den Street
    St Augustine,FL32092
    JOHN D BAILEY JR Trustee
    0.40
    0 0 0
    350 Fiddlers Ct
    St Augustine,FL32080
    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 ST. JOHNS COUNTY WELFARE FEDERATIONASSISTED LIVING FACILITY, MEDICAL CARE, EMERGENCY FOOD ANDUTILITIES FOR INDIGENT AFRICAN-AMERICANS IN THE ST. AUGUSTINE, FL AREA 70,000
    2 ST. JOHNS HOUSING PARTNERSHIP, INC.ASSIST WITH REPAIRS TO HOUSING USED BY INDIGENT AFRICAN-AMERICANSLIVING IN THE ST. AUGUSTINE, FL AREA 54,741
    3 YOUNG LIFE ST. AUGUSTINEASSIST WITH TUTORING, COUNSELING, AND MENTORING SERVICES FOR INDIGENT AFRICAN-AMERICANSLIVING IN THE ST. AUGUSTINE, FL AREA 49,610
    4 GOOD SAMARITAN HEALTH CLINIC, INC.PROVIDE MEDICAL AND HEALTH SERVICES FOR INDIGENTAFRICAN-AMERICANS LIVING IN THE ST. AUGUSTINE, FL AREA 33,000
    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
    6,182,730
    b
    Average of monthly cash balances.......................
    1b
    19,648
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    6,202,378
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
    6,202,378
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    93,036
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    6,109,342
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    305,467
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    305,467
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    1,840
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,840
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    303,627
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    303,627
    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
    303,627
    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
    325,027
    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
    325,027
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see instructions).................
    5
    1,840
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    323,187
    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 7 303,627
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 8,697
    b From 2011...... 7,900
    c From 2012...... 15,681
    d From 2013...... 4,191
    e From 2014...... 10,427
    fTotal of lines 3a through e........ 46,896
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 325,027
    a Applied to 2014, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions).....
     
    c Treated as distributions out of corpus (Election
    required—see instructions)........
     
    d Applied to 2015 distributable amount..... 303,627
    e Remaining amount distributed out of corpus 21,400
    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 68,296
    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 ..........
    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) .......
     
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...
    8,697
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......
    59,599
    10 Analysis of line 9:
    a Excess from 2011.... 7,900
    b Excess from 2012.... 15,681
    c Excess from 2013.... 4,191
    d Excess from 2014.... 10,427
    e Excess from 2015.... 21,400
    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 e-mail address of the person to whom applications should be addressed:
    BRADLEY K DAVIS
    17 PACIFIC STREET SUITE A
    SAINT AUGUSTINE,FL32084
    (904) 819-1799
    bThe form in which applications should be submitted and information and materials they should include:
    DESCRIBE BENEFITS TO INDIGENT AFRICAN-AMERICAN RESIDENTS OF SAINT AUGUSTINE, FL.
    cAny submission deadlines:
    SEPTEMBER 15TH FOR FOLLOWING CALENDAR YEAR.
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    MUST BENEFIT INDIGENT AFRICAN-AMERICANS RESIDING IN SAINT AUGUSTINE, FL.
    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
    St Johns Housing Partnership Inc
    PO Box 1086
    St Augustine,FL32085
      501(c)(3) housing unitsRepairs to 54,741
    St Joseph Academy
    155 SR 207
    St Augustine,FL32086
      501(c)(3) youthScholarships for 11,000
    Flagler College Inc
    74 King St-PO Box 1027
    St Augustine,FL32084
      501(c)(3) youthScholarships for 8,690
    St Johns County Welfare Federation
    161-B Marine St
    St Augustine,FL32084
      501(c)(3) facility and emergencyAssisted livingliving assistance 70,000
    Flagler Health Care Foundation Inc
    400 Health Park Blvd
    St Augustine,FL32086
      501(c)(3) indigent patientsHealth care for 30,000
    St Johns County Council on Aging
    180 Marine St
    St Augustine,FL32084
      501 (c)(3) for indigentsMeals on Wheels- 30,000
    Safety Shelter of St Johns County Inc
    PO Box 3319
    St Augustine,FL32085
      501 (c)(3) victims of domesticAssistance forviolence 15,000
    Young Life St Augustine
    PO Box 9012
    St Augustine,FL32085
      501 (c)(3) mentoring, etc. toProvide tutoring,indigent youth 49,610
    Good Samaritan Health Centers Inc
    39 Lovett St PO Box 1005
    St Augustine,FL32080
      501 (c)(3) medicalProvideservices 33,000
    Flagler College Inc
    74 King Street
    St Augustine,FL32084
      501 (c)(3) assistance toProvide educationallow income youth. 12,500
    Total .................................bullet 3a 314,541
    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 3  
    4 Dividends and interest from securities....     14 171,742  
    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 76,936  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue:
    aMISCELLANEOUS
        14 11,460  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   260,141  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13260,141
    (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:  
    Part VI Line 7 -Original Return Overpayment: -4,980


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2015 AccountingFeesSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    DAVIS & DAVIS-CERTIFIED PUBLIC ACCTS, PA COMPILATION/BOOKKEEPING/TAX PREPARATION,ETC. 19,900 9,950   9,950

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2015 GainLossSaleOtherAssetsSch
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Name Date Acquired How Acquired Date Sold Purchaser Name Gross Sales Price Basis Basis Method Sales Expenses Total (net) Accumulated Depreciation
    SALES OF INVESTMENTS   Purchased   US TRUST-BANK OF AMERICA 1,895,599 1,839,868     55,731  
    CAPITAL GAIN DISTRIBUTIONS   Purchased   US TRUST-BANK OF AMERICA-CAPITAL GA 21,205       21,205  

    TY 2015 InvestmentsCorpBondsSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Name of Bond End of Year Book Value End of Year Fair Market Value
    American Express Corp-50,000 SH 50,244 49,995
    Amgen Inc-50,000 SH 50,578 50,288
    Apple Inc-50,000 SH 49,623 49,594
    Bank New York Inc-50,000 SH 51,096 50,026
    Bank Nova Scotia BC SR-50,000 SH 49,316 49,609
    BB&T Corp-50,000 SH 51,084 50,386
    BP Cap Mkts PLC SR-50,000 SH 49,312 49,283
    Caterpillar Finl Svcs Corp-50,000 SH 50,174 50,133
    Chevron Corp New-50,000 SH 50,552 49,744
    Cisco System Inc-50,000 SH 50,772 50,429
    Citigroup Inc Global-50,000 SH 53,002 53,438
    Deere John Cap Corp-50,000 SH 50,760 50,212
    General Electric Cap-50,000 SH 53,597 52,272
    General Electric Co-50,000 SH 55,852 53,384
    Home Depot Inc SR-50,000 SH 50,893 51,120
    Ishares IBoxx High Yield Corp Bd Fund-1,550 SH 117,521 124,899
    Johnson & Johnson NT-50,000 SH 57,443 53,471
    JPMorgan Chase & Co SR-50,000 SH 50,587 50,209
    Oracle Corp-50,000 SH 50,394 50,522
    Pfizer Inc-50,000 SH 50,409 50,444
    Philip Morris Intl-50,000 SH 51,280 50,307
    Prudential Short Term Corporate Bd-8,343.952 SH 93,703 92,034
    SPDR Barclays High Yield Bond-1,000 SH 33,933 33,910
    Toyota Mtr Corp-50,000 SH 50,925 50,015
    Wal Mart Stores Inc-50,000 SH 56,448 52,657
    Wells Fargo & Co New SR NT-50,000 51,053 50,625
    UnitedHealth Group Inc-50,000 SH 49,309 49,447

    TY 2015 InvestmentsCorpStockSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Name of Stock End of Year Book Value End of Year Fair Market Value
    Abbvie Inc-63 SH 3,845 3,732
    ACE LTD-113 SH 11,017 13,204
    Activision Blizzard-210 SH 7,911 8,129
    Acuity Brands-49 SH 10,195 11,456
    Adobe System Inc-207 SH 16,662 19,446
    Alexion Pharmaceuticals-123 SH 12,188 23,462
    Alibaba Group Hldg-180 SH 12,517 14,629
    Altria Group Inc-293 SH 11,126 17,056
    Amazon Com-27 SH 1,881 18,249
    American Electric Power-91 SH 4,264 5,303
    Apple Inc-208 SH 17,071 21,894
    AQR Managed Futures Strategy Fund-2,194.302 SH 23,918 22,338
    Automatic Data Processing Inc-112 SH 7,061 9,489
    Biogen Idec Inc-59 SH 10,564 18,075
    Blackrock Inc-37 SH 10,737 12,599
    Blackstone Alternative Mulitstrategy-3,272.587 SH 34,395 33,119
    Boeing Co-76 SH 7,965 10,989
    Bristol Myers Squibb-342 SH 18,197 23,526
    Bristol Myers Squibb-174 SH 11,590 11,969
    Celgene Corp-146 SH 4,790 17,485
    Chevron-7,125 SH 22,767 640,965
    Chubb Corp-66 SH 5,743 8,754
    Cisco System Inc-473 SH 12,189 12,844
    Cognizant Tech-262 SH 7,315 15,725
    Columbia Smallcap Value Fund-Mutual Funds-3,436.477 SH 39,995 52,338
    CME Group Inc-131 SH 10,205 11,869
    CMS Energy Corp-115 SH 3,262 4,149
    Comcast Corp-334 SH 17,536 18,848
    Crown Castle Intl-46 SH 3,957 3,977
    CVS Health Corp-164 SH 16,905 16,034
    CVS Health Corp-149 SH 11,543 14,568
    Dexcom Inc-127 SH 11,988 10,401
    Dominion Res Inc-50 SH 2,980 3,382
    Dover Corp-95 SH 6,938 5,824
    Eastman Chemical-71 SH 5,857 4,793
    Essex PPTY-17 SH 3,969 4,070
    Etracs Alerian MLP-2,200 SH 87,711 57,552
    Eversource Energy-95 SH 4,671 4,852
    Exxon Mobil-11,575 SH 22,336 902,271
    Exxon Mobil-351 SH 30,786 27,360
    Facebook Inc-223 SH 6,696 23,339
    Fitbit Inc-451 SH 16,603 13,345
    General Dynamics Corp-81 SH 12,206 11,126
    General Electric-607 SH 15,742 18,908
    General Mills-206 SH 10,945 11,878
    Genuine Parts Co-53 SH 4,788 4,552
    Gilead Sciences-111 SH 10,987 11,232
    Home Depot-169 SH 6,883 22,350
    Honeywell Intl Inc-168 SH 14,659 17,400
    Illumina Inc-102 SH 16,518 19,578
    Intel Corp-259 SH 6,005 8,923
    Intercept Pharmaceuticals Inc-96 SH 21,126 14,338
    Intercontinental Exchange-54 SH 12,910 13,838
    Ishares Select Div Index-2,750 SH 145,185 206,663
    Ishares Russell 2000 Index Fund-2,000 SH 92,889 225,240
    Janus Invt Fund Enterprise-399.874 SH 12,801 34,577
    JP Morgan Chase & Co-350 SH 19,763 23,111
    John Hancock FDS III Disciplined Value-1,452.644 SH 25,000 27,818
    Johnson & Johnson-238 SH 22,449 24,447
    Kalmar Pooled Small Cap Growth-2,374.321 SH 40,947 34,665
    Kimberly Clark Corp-92 SH 8,646 11,712
    Linkedin Corp-99 SH 14,256 22,283
    Lockheed Martin Corp-61 SH 11,987 13,246
    Lyondellbase Industries-46 SH 3,951 3,997
    Marsh & Mclennan Cos Inc-203 SH 9,133 11,256
    Medtronic PLC-77 SH 5,925 5,923
    Mercadolibre Inc-145 SH 16,844 16,579
    McDonalds Corp-72 SH 7,026 8,506
    Merck & Co Inc-363 SH 18,136 19,174
    Microsoft Corp-648 SH 22,595 35,951
    Mobileye NV-516 SH 23,829 21,817
    Monster Beverage Corp-133 SH 17,922 19,812
    Natixis Fds TR II-4,250.218 SH 47,179 45,223
    Nike Inc-272 SH 13,087 17,000
    Nextera Energy Inc-57 SH 4,872 5,922
    Northern TR Corp-125 SH 9,205 9,011
    Novo Nordisk-259 SH 14,422 15,043
    Occidental Pete-107 SH 8,152 7,234
    Parker Hannifin Corp-42 SH 4,274 4,073
    Pepsico Inc-122 SH 11,671 12,190
    Pfizer Inc-562 SH 16,712 18,141
    PG&E Corp-102 SH 5,853 5,425
    Philip Morris Intl-208 SH 16,952 18,285
    PNC Financial Services Group-112 SH 8,464 10,675
    Price T Rowe Group-69 SH 5,169 4,933
    Priceline Com Inc-14 SH 1,722 17,849
    Procter & Gamble Co-148 SH 11,877 11,753
    Powershares QQQ Tr Unit-500 SH 27,743 55,930
    Public Storage Inc-64 SH 11,379 15,853
    Robeco Boston Partners-4,568.487 SH 65,821 68,116
    Sempra Energy-46 SH 4,025 4,324
    Servicenow Inc-196 SH 14,810 16,966
    Schlumberger LTD-212 SH 18,047 14,787
    Sherwin Williams Co-38 SH 6,620 9,865
    Simon PPTY Group Inc-37 SH 5,759 7,194
    Skyworks Solutions Inc.-169 SH 14,201 12,984
    SPDR S&P Midcap 400-1,400 SH 123,172 355,656
    Splunk Inc-325 SH 17,399 19,113
    Tesla Mtrs Inc-54 SH 8,489 12,961
    Texas Instruments Inc-178 SH 6,683 9,756
    Time Warner Inc-128 SH 10,871 8,278
    TJX Cos Inc-67 SH 4,726 4,751
    United Parcel Service Inc-124 SH 11,248 11,933
    US Bancorp-190 SH 7,102 8,107
    V F Corp-64 SH 3,161 3,984
    Valero Energy-105 SH 7,549 7,424
    Vanguard FTSE All World-Mutual Funds-2,500 SH 116,955 108,525
    Vanguard FTSE Developed Markets-4,000 SH 153,556 146,880
    Vanguard FTSE Emerging Markets-4,500 SH 183,400 147,195
    Verizon Communications-371 SH 17,278 17,148
    Vertex Pharmaceuticals-178 SH 14,877 22,398
    Visa Inc-264 SH 6,527 20,473
    Walmart Stores Inc-65 SH 4,927 3,985
    Waste Management-93 SH 3,901 4,963
    WEC Energy Group-73 SH 3,168 3,746
    Wells Fargo & Co-383 SH 11,838 20,820

    TY 2015 InvestmentsOtherSchedule2
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    Bank of America - Money Market Funds   36,031 36,031

    TY 2015 OtherAssetsSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879


    TY 2015 OtherAssetsSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879


    TY 2015 OtherAssetsSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879
    FEDERAL INCOME TAX DEPOSIT 4,980 3,140 3,140
    DUE FROM US TRUST 11,087 14,879 14,879


    TY 2015 OtherExpensesSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BANK CHARGES 50,633 50,633    
    D & O INSURANCE 900 450   450
    OFFICE EXPENSE 29 14   15
    INVESTMENT FEES 14,064 14,064    


    TY 2015 OtherIncomeSchedule2
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    MISCELLANEOUS 11,460 11,460  


    TY 2015 OtherLiabilitiesSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Description Beginning of Year - Book Value End of Year - Book Value
    DUE TO US TRUST 34,147 4,675
    DUE TO US TRUST 34,147 4,675


    TY 2015 OtherLiabilitiesSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Description Beginning of Year - Book Value End of Year - Book Value
    DUE TO US TRUST 34,147 4,675
    DUE TO US TRUST 34,147 4,675


    TY 2015 TaxesSchedule
    Name:
    BUCKINGHAM SMITH BENEVOLENT ASSOCIATION
    EIN:
    59-6137514
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LICENSES & TAXES 2,958 1,047   71