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 10-01-2015 , and ending 09-30-2016
Name of foundation
SOUTHMAYD HOME INC
 
Number and street (or P.O. box number if mail is not delivered to street address)250 COLUMBIA BLVD
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WATERBURY, CT06710
A Employer identification number

06-0646903
B Telephone number (see instructions)

(203) 754-0360
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$11,001,732J 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) 54,182
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 193,656 193,656 193,656
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 102,457
b Gross sales price for all assets on line 6a 3,197,234
7 Capital gain net income (from Part IV, line 2)... 102,457
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)....... Click to see attachment 595,505   595,505
12 Total. Add lines 1 through 11........ 945,800 296,113 789,161
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages...... 763,060   175,220 587,840
15 Pension plans, employee benefits....... 138,494   31,802 106,692
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 9,710 3,300 2,230 4,180
17 Interest...............        
18 Taxes (attach schedule) (see instructions)...        
19 Depreciation (attach schedule) and depletion... Click to see attachment 51,070   11,727
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 427,538 51,455 90,764 285,319
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 1,389,872 54,755 311,743 984,031
25 Contributions, gifts, grants paid....... 0 0
26 Total expenses and disbursements. Add lines 24 and 25 1,389,872 54,755 311,743 984,031
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -444,072
b Net investment income (if negative, enter -0-) 241,358
c Adjusted net income (if negative, enter -0-)... 477,418
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............. 415 415 415
2 Savings and temporary cash investments......... 1,046,567 956,996 956,996
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.............. 6,000 6,000 6,000
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule) 868,399 Click to see attachment679,973 679,973
b Investments—corporate stock (attach schedule)....... 6,847,771 Click to see attachment6,558,702 6,558,702
c Investments—corporate bonds (attach schedule)....... 1,852,666 Click to see attachment2,426,857 2,426,857
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis bullet2,063,784
Less: accumulated depreciation (attach schedule) bullet1,714,239 383,558 Click to see attachment349,545 349,545
15 Other assets (describe bullet) Click to see attachment27,219 Click to see attachment23,244 Click to see attachment23,244
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 11,032,595 11,001,732 11,001,732
Liabilities 17 Accounts payable and accrued expenses.......... 3,843 11,845
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)......... 3,843 11,845
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................. 11,017,965 10,979,100
25 Temporarily restricted............... 10,787 10,787
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see instructions)..... 11,028,752 10,989,887
31 Total liabilities and net assets/fund balances (see instructions). 11,032,595 11,001,732
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
11,028,752
2
Enter amount from Part I, line 27a .....................
2
-444,072
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
405,207
4
Add lines 1, 2, and 3 ..........................
4
10,989,887
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
10,989,887
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 500 MONDELEZ INTERNATIONAL P 2014-11-05 2015-10-08
b 100 PEPSICO P 2014-12-16 2015-10-21
c 50 HALLIBURTON CO HLDG P 2010-04-21 2015-11-18
d 14.41 VANGUARD WELLESLEY INCOME FD C P   2015-12-17
e 25 PNC FINANCIAL SERVICES GRP INC P 2013-10-25 2016-01-26
50000 BANK OF OKLAHOMA 0.9221 05/15 P 2010-10-19 2016-02-11
100 PEPSICO P 2012-02-13 2016-03-22
100 EXXON MOBIL CORPORATION P 2015-09-30 2016-05-11
200 DOLLAR GENERAL CORP. P 2015-10-20 2016-06-28
200 PEPSICO P 1986-01-08 2016-07-06
5 VISA INC P 2011-08-22 2016-07-21
100 EATON CORP PLC P 2014-07-30 2016-08-22
100 NIKE INC - CL B P 2014-02-07 2015-10-08
100 PEPSICO P 2014-12-18 2015-10-21
50 HALLIBURTON CO HLDG P 2011-10-04 2015-11-18
61 VANGUARD WELLESLEY INCOME FD CL A P   2015-12-17
25 PNC FINANCIAL SERVICES GRP INC P 2015-10-16 2016-01-26
200 CVS HEALTH CORP P 2005-02-24 2016-02-11
100 PEPSICO P 2014-12-15 2016-03-22
200 EXXON MOBIL CORPORATION P 2011-10-06 2016-05-13
10 METTLER-TOLEDO INTERNATIONAL P 2014-07-30 2016-06-28
200 JOHNSON & JOHNSON P 2001-06-04 2016-07-14
20 VISA INC P 2014-05-01 2016-07-21
200 EATON CORP PLC P 2013-07-11 2016-08-22
5 W.W. GRAINGER, INC. P 2014-01-16 2015-10-16
200 NIKE INC - CL B P 2011-04-06 2015-10-27
200 HALLIBURTON CO HLDG P 2011-10-04 2015-11-18
100 BECTON DICKINSON P 2015-09-10 2015-12-22
25 PNC FINANCIAL SERVICES GRP INC P 2013-10-17 2016-01-26
300 CVS HEALTH CORP P 2015-12-15 2016-02-11
300 PEPSICO P 2011-08-11 2016-03-22
15000 AIRGAS INC 2.95 06/15/16 P 2011-07-28 2016-05-17
500 PRUDENTIAL FINANCIAL INC. P 2015-12-04 2016-06-28
50 UNION PACIFIC CORPORATION P 2015-06-22 2016-07-19
5 UNION PACIFIC CORPORATION P 2013-07-12 2016-07-22
200 EATON CORP PLC P 2014-09-17 2016-08-22
5 W.W. GRAINGER, INC. P 2014-04-23 2015-10-16
100 VISA INC P 2013-08-13 2015-10-27
500 HALLIBURTON CO HLDG P 2010-04-13 2015-11-18
100 BECTON DICKINSON P 2015-09-25 2015-12-22
25 PNC FINANCIAL SERVICES GRP INC P 2015-10-16 2016-01-26
1000 SUNTRUST BANKS P 2015-10-16 2016-02-11
200 MONDELEZ INTERNATIONAL P 2015-03-25 2016-04-26
35000 AIRGAS INC 2.95 06/15/16 P 2011-07-28 2016-05-17
1000 SUNTRUST BANKS P 2013-03-07 2016-06-28
100 UNION PACIFIC CORPORATION P 2015-07-16 2016-07-19
20 UNION PACIFIC CORPORATION P 2013-07-11 2016-07-22
300 EATON CORP PLC P 2013-06-13 2016-08-22
25 W.W. GRAINGER, INC. P 2014-01-16 2015-10-16
100 EXXON MOBIL CORPORATION P 2014-09-26 2015-11-04
1800 HALLIBURTON CO HLDG P 2010-04-06 2015-11-18
200 FACEBOOK INC. P 2015-07-16 2015-12-22
50 PNC FINANCIAL SERVICES GRP INC P 2013-10-17 2016-01-26
100 VISA INC P 2011-08-11 2016-02-11
500 MONDELEZ INTERNATIONAL P 2014-12-18 2016-04-26
100 BECTON DICKINSON P 2007-11-30 2016-05-17
10 VALEANT PHARMACEUTICALS P 2015-02-11 2016-06-28
200 UNION PACIFIC CORPORATION P 2015-04-29 2016-07-19
50 UNION PACIFIC CORPORATION P 2013-10-17 2016-07-22
300 MONDELEZ INTERNATIONAL P 2015-03-25 2016-08-30
50 W.W. GRAINGER, INC. P 2014-07-22 2015-10-16
200 EXXON MOBIL CORPORATION P 2013-08-28 2015-11-04
300 VISA INC P 2013-08-13 2015-11-18
300 OLD DOMINION FREIGHT LINE P 2015-06-05 2015-12-22
300 PNC FINANCIAL SERVICES GRP INC P 2015-10-15 2016-01-26
200 VISA INC P 2013-08-13 2016-02-11
800 MONDELEZ INTERNATIONAL P 2015-02-11 2016-04-26
100 BECTON DICKINSON P 2008-05-20 2016-05-17
15 VALEANT PHARMACEUTICALS P 2015-01-26 2016-06-28
200 UNION PACIFIC CORPORATION P 2015-09-15 2016-07-19
300 UNION PACIFIC CORPORATION P 2015-12-31 2016-07-22
300 PEPSICO P 1986-01-08 2016-08-30
100 W.W. GRAINGER, INC. P 2014-02-13 2015-10-16
200 VISA INC P 2013-08-13 2015-11-04
25 ALPHABET INC CLASS A P 2006-07-21 2015-12-04
500 OLD DOMINION FREIGHT LINE P 2015-06-22 2015-12-22
500 PNC FINANCIAL SERVICES GRP INC P 2015-10-16 2016-01-26
100000 CISCO SYSTEMS 5.5 02/22/16 P 2006-10-31 2016-02-22
20000 U S TREASURY NOTES P 2014-01-31 2016-05-02
100 FACEBOOK INC. P 2015-08-24 2016-05-17
50 VALEANT PHARMACEUTICALS P 2015-02-11 2016-06-28
300 UNION PACIFIC CORPORATION P 2013-07-11 2016-07-19
600 UNION PACIFIC CORPORATION P 2013-10-17 2016-07-22
100000 HERSHEY COMPANY 5.45 09/01/1 P 2008-05-06 2016-09-01
100 W.W. GRAINGER, INC. P 2014-09-26 2015-10-16
18 ALLERGAN PLC P 2015-03-17 2015-11-12
25 ALPHABET INC CLASS A P 2014-06-09 2015-12-04
100 ACCENTURE LTD - CL A P 2010-05-12 2016-01-22
1500 PNC FINANCIAL SERVICES GRP INC P 2013-10-17 2016-01-26
200 EATON CORP PLC P 2014-07-30 2016-02-29
25000 U S TREASURY NOTES P 2014-01-30 2016-05-02
100 FACEBOOK INC. P 2015-08-25 2016-05-17
50 VALEANT PHARMACEUTICALS P 2015-03-10 2016-06-28
25 ANADARKO PETROLEUM P 2015-05-14 2016-07-21
1100 UNION PACIFIC CORPORATION P 2013-07-11 2016-07-22
100 W.W. GRAINGER, INC. P 2014-12-16 2015-10-16
22.32 ALLERGAN PLC P 2015-03-17 2015-11-12
25 ALPHABET INC CLASS C P 2006-07-21 2015-12-04
200 ACCENTURE LTD - CL A P 2012-12-21 2016-01-22
200 WELLS FARGO COMPANY P 2010-03-11 2016-01-26
300 EATON CORP PLC P 2013-10-30 2016-02-29
25000 U S TREASURY NOTES P 2014-09-17 2016-05-02
75000 CINTAS CORPORATION NO. 2 2.85 P 2015-06-03 2016-06-01
50 VALEANT PHARMACEUTICALS P 2015-01-22 2016-06-28
10 BECTON DICKINSON P 2011-11-07 2016-07-21
100 METTLER-TOLEDO INTERNATIONAL P 2014-05-01 2016-08-03
100 W.W. GRAINGER, INC. P 2015-01-30 2015-10-16
109.68 ALLERGAN PLC P 2015-03-17 2015-11-12
25 ALPHABET INC CLASS C P 2014-05-01 2015-12-04
100 VMWARE INC. P 2014-07-23 2016-01-22
200 DOLLAR GENERAL CORP. P 2015-03-16 2016-01-29
100 DOLLAR GENERAL CORP. P 2015-09-24 2016-03-10
50000 U S TREASURY NOTES P 2013-12-19 2016-05-02
500 SUNTRUST BANKS P 2013-03-07 2016-06-13
100 VALEANT PHARMACEUTICALS P 2015-01-27 2016-06-28
25 LOWE`S COMPANIES P 2013-06-06 2016-07-21
100 METTLER-TOLEDO INTERNATIONAL P 2014-05-09 2016-08-03
250 W.W. GRAINGER, INC. P 2014-04-23 2015-10-16
40000 U S TREASURY NOTES P 2013-10-24 2015-11-16
700 VMWARE INC. P 2014-07-23 2015-12-15
200 VMWARE INC. P 2014-05-16 2016-01-22
200 DOLLAR GENERAL CORP. P 2015-03-25 2016-01-29
100 MONDELEZ INTERNATIONAL P 2014-11-05 2016-03-22
75000 U S TREASURY NOTES P 2014-01-16 2016-05-02
100 BECTON DICKINSON P 2007-11-30 2016-06-28
100 VALEANT PHARMACEUTICALS P 2015-03-16 2016-06-28
5 METTLER-TOLEDO INTERNATIONAL P 2014-05-01 2016-07-21
25 PRUDENTIAL FINANCIAL INC. P 2015-12-04 2016-08-03
100 NIKE INC - CL B P 2011-04-13 2015-10-20
50000 U S TREASURY NOTES P 2010-09-02 2015-11-16
217.02 VANGUARD WELLESLEY INCOME FD P   2015-12-17
200 VMWARE INC. P 2014-09-18 2016-01-22
500 DUNKIN` BRANDS GROUP INC P 2014-06-03 2016-01-29
200 MONDELEZ INTERNATIONAL P 2015-02-11 2016-03-22
200 DOLLAR GENERAL CORP. P 2015-09-24 2016-05-10
20 DOLLAR GENERAL CORP. P 2015-03-12 2016-06-28
100 VALEANT PHARMACEUTICALS P 2015-10-16 2016-06-28
50 MONDELEZ INTERNATIONAL P 2014-11-05 2016-07-21
50 PRUDENTIAL FINANCIAL INC. P 2015-12-04 2016-08-03
100 NIKE INC - CL B P 2014-02-07 2015-10-20
100000 U S TREASURY NOTES P 2007-02-23 2015-11-16
576.19 VANGUARD WELLESLEY INCOME FD P   2015-12-17
200 ACCENTURE LTD - CL A P 2010-07-22 2016-01-26
100 JOHNSON & JOHNSON P 2015-09-10 2016-01-29
300 MONDELEZ INTERNATIONAL P 2014-11-05 2016-03-22
300 DOLLAR GENERAL CORP. P 2015-01-22 2016-05-10
25 DOLLAR GENERAL CORP. P 2015-01-22 2016-06-28
200 VALEANT PHARMACEUTICALS P 2015-10-08 2016-06-28
20 PEPSICO P 2014-01-30 2016-07-21
1200 PRUDENTIAL FINANCIAL INC. P 2015-12-04 2016-08-03
500 MONDELEZ INTERNATIONAL P 2014-11-05 2015-10-21
200 ANADARKO PETROLEUM P 2014-11-21 2015-11-18
2441 VANGUARD WELLESLEY INCOME FD CL P   2015-12-17
25 ALPHABET INC CLASS A P 2006-07-21 2016-01-26
200 JOHNSON & JOHNSON P 2015-09-30 2016-01-29
25 PEPSICO P 2007-10-17 2016-03-22
100 EXXON MOBIL CORPORATION P 2013-08-28 2016-05-11
100 DOLLAR GENERAL CORP. P 2015-01-22 2016-06-28
700 VALEANT PHARMACEUTICALS P 2015-01-22 2016-06-28
50 SUNTRUST BANKS P 2015-10-16 2016-07-21
1500 PRUDENTIAL FINANCIAL INC. P 2016-01-22 2016-08-03
100 PEPSICO P 2012-02-13 2015-10-21
50 HALLIBURTON CO HLDG P 2010-04-06 2015-11-18
5.43 VANGUARD WELLESLEY INCOME FD CL P   2015-12-17
25 ALPHABET INC CLASS C P 2006-07-21 2016-01-26
800 DUNKIN` BRANDS GROUP INC P 2014-06-03 2016-02-04
25 PEPSICO P 2014-01-30 2016-03-22
100 EXXON MOBIL CORPORATION P 2015-07-16 2016-05-11
200 DOLLAR GENERAL CORP. P 2012-12-13 2016-06-28
100 EXXON MOBIL CORPORATION P 2011-10-06 2016-07-06
25 UNION PACIFIC CORPORATION P 2016-05-31 2016-07-21
1500 PRUDENTIAL FINANCIAL INC. P 2016-03-22 2016-08-03
(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 22,261   18,540 3,721
b 10,035   9,357 678
c 1,926   1,672 254
d 14     14
e 2,078   1,887 191
48,375   50,000 -1,625
10,061   6,369 3,692
8,901   7,397 1,504
18,457   13,428 5,029
21,169   758 20,411
389   101 288
6,753   7,000 -247
12,382   7,191 5,191
10,035   9,435 600
1,917   1,409 508
61     61
2,078   2,206 -128
18,570   4,858 13,712
10,061   9,546 515
17,719   14,651 3,068
3,549   2,612 937
24,657   9,851 14,806
1,558   1,051 507
13,507   13,549 -42
1,047   1,344 -297
26,110   7,881 18,229
7,740   5,610 2,130
15,335   13,594 1,741
2,074   1,867 207
27,856   28,411 -555
30,182   18,650 11,532
15,000   15,194 -194
34,332   42,898 -8,566
4,678   5,092 -414
449   405 44
13,507   13,316 191
1,047   1,294 -247
7,742   4,484 3,258
19,350   15,557 3,793
15,335   13,963 1,372
2,074   2,206 -132
32,010   40,144 -8,134
8,440   7,117 1,323
35,000   35,453 -453
39,140   28,577 10,563
9,372   9,647 -275
1,797   1,603 194
20,260   19,209 1,051
5,262   6,649 -1,387
8,585   9,499 -914
69,661   58,103 11,558
21,003   17,982 3,021
4,157   3,717 440
6,875   2,070 4,805
21,100   18,253 2,847
16,595   8,205 8,390
192   1,655 -1,463
18,745   21,384 -2,639
4,524   3,896 628
13,377   10,676 2,701
10,559   12,112 -1,553
17,170   17,735 -565
23,938   13,452 10,486
17,376   20,996 -3,620
24,993   26,090 -1,097
13,749   8,968 4,781
33,760   29,294 4,466
16,595   8,407 8,188
288   2,420 -2,132
18,745   17,529 1,216
27,196   23,587 3,609
32,198   8,595 23,603
21,118   23,903 -2,785
15,675   8,968 6,707
19,425   4,873 14,552
28,959   35,813 -6,854
41,655   43,764 -2,109
100,000   101,001 -1,001
20,000   20,714 -714
11,798   8,650 3,148
1,000   8,195 -7,195
28,117   23,770 4,347
54,392   46,546 7,846
100,000   101,877 -1,877
21,118   25,201 -4,083
5,631   5,522 109
19,425   14,249 5,176
10,072   4,146 5,926
124,964   110,970 13,994
11,461   14,000 -2,539
25,000   25,884 -884
11,798   8,534 3,264
1,000   10,200 -9,200
1,339   2,147 -808
99,718   87,158 12,560
21,118   24,676 -3,558
6,983   6,808 175
19,054   4,863 14,191
20,144   13,560 6,584
9,631   5,931 3,700
17,191   21,462 -4,271
25,000   25,660 -660
75,000   76,538 -1,538
991   7,908 -6,917
1,722   739 983
39,997   23,554 16,443
21,118   23,538 -2,420
34,314   33,452 862
19,054   13,255 5,799
4,891   9,736 -4,845
22,511   22,502 9
16,467   14,243 2,224
50,000   51,826 -1,826
21,019   14,289 6,730
1,999   16,062 -14,063
1,978   1,010 968
39,997   24,091 15,906
52,796   63,832 -11,036
40,000   43,459 -3,459
40,605   68,153 -27,548
9,781   18,803 -9,022
15,007   15,078 -71
4,040   3,726 314
75,000   77,595 -2,595
16,354   8,205 8,149
1,999   20,257 -18,258
1,900   1,196 704
1,858   2,163 -305
13,256   3,973 9,283
50,000   57,762 -7,762
217     217
9,781   19,256 -9,475
19,536   22,983 -3,447
8,094   7,323 771
8,425   7,122 1,303
1,826   1,495 331
1,999   17,629 -15,630
2,237   1,872 365
3,748   4,307 -559
13,256   7,191 6,065
100,000   98,781 1,219
576     576
20,502   7,927 12,575
10,437   9,320 1,117
12,142   11,124 1,018
16,850   13,790 3,060
2,299   1,732 567
3,998   33,702 -29,704
2,144   1,640 504
90,157   102,954 -12,797
22,637   18,540 4,097
12,237   18,776 -6,539
2,441     2,441
18,311   4,873 13,438
20,874   18,690 2,184
2,511   1,810 701
8,901   8,868 33
9,228   6,895 2,333
13,994   110,475 -96,481
2,140   2,025 115
11,270   10,424 846
10,035   6,369 3,666
1,926   1,618 308
5     5
17,810   4,863 12,947
32,482   36,772 -4,290
2,511   2,050 461
8,901   8,327 574
18,457   9,016 9,441
9,335   7,325 2,010
2,261   2,121 140
11,270   11,144 126
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       3,721
b       678
c       254
d       14
e       191
      -1,625
      3,692
      1,504
      5,029
      20,411
      288
      -247
      5,191
      600
      508
      61
      -128
      13,712
      515
      3,068
      937
      14,806
      507
      -42
      -297
      18,229
      2,130
      1,741
      207
      -555
      11,532
      -194
      -8,566
      -414
      44
      191
      -247
      3,258
      3,793
      1,372
      -132
      -8,134
      1,323
      -453
      10,563
      -275
      194
      1,051
      -1,387
      -914
      11,558
      3,021
      440
      4,805
      2,847
      8,390
      -1,463
      -2,639
      628
      2,701
      -1,553
      -565
      10,486
      -3,620
      -1,097
      4,781
      4,466
      8,188
      -2,132
      1,216
      3,609
      23,603
      -2,785
      6,707
      14,552
      -6,854
      -2,109
      -1,001
      -714
      3,148
      -7,195
      4,347
      7,846
      -1,877
      -4,083
      109
      5,176
      5,926
      13,994
      -2,539
      -884
      3,264
      -9,200
      -808
      12,560
      -3,558
      175
      14,191
      6,584
      3,700
      -4,271
      -660
      -1,538
      -6,917
      983
      16,443
      -2,420
      862
      5,799
      -4,845
      9
      2,224
      -1,826
      6,730
      -14,063
      968
      15,906
      -11,036
      -3,459
      -27,548
      -9,022
      -71
      314
      -2,595
      8,149
      -18,258
      704
      -305
      9,283
      -7,762
      217
      -9,475
      -3,447
      771
      1,303
      331
      -15,630
      365
      -559
      6,065
      1,219
      576
      12,575
      1,117
      1,018
      3,060
      567
      -29,704
      504
      -12,797
      4,097
      -6,539
      2,441
      13,438
      2,184
      701
      33
      2,333
      -96,481
      115
      846
      3,666
      308
      5
      12,947
      -4,290
      461
      574
      9,441
      2,010
      140
      126
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 2 102,457
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 -61,532
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      
2013      
2012      
2011      
2010      
2
Total of line 1, column (d) .....................
2  
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
 
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
 
5
Multiply line 4 by line 3......................
5
 
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
 
7
Add lines 5 and 6........................
7
 
8
Enter qualifying distributions from Part XII, line 4.............
8
 
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: 1989-11-09(attach copy of letter if necessary–see instructions)
b 1 N/A
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2........................... 3  
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  
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a  
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7  
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 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  
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet   RefundedBullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for definition)?.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
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)
    bullet
    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
    Yes
     
    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 ofbulletKIMBERLY PEREIRA Telephone no.bullet (203) 754-0360

    Located atbullet250 COLUMBIA BLVDWATERBURYCT ZIP+4bullet06710
    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
     
     
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2015 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2015.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (Continued)
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? (see instructions)................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    BONNIE LEAVENWORTH PRESIDENT
    1.00     		0 0 0
    365 WHITE DEER ROCK ROAD
    WOODBURY,CT06798
    JANET DAYTON DIRECTOR
    1.00     		0 0 0
    249 OLD FARMS RD
    WATERTOWN,CT06795
    PATRICIA EMONS VICE PRESIDE
    1.00     		0 0 0
    6 PRATTE LANE
    WOLCOTT,CT06716
    ATTY MARY JANE RYAN SECRETARY
    1.00     		0 0 0
    22 BIGWOOD LANE
    BURLINGTON,CT06013
    ELAINE PUZZO DIRECTOR
    1.00     		0 0 0
    42 AVALON DRIVE AVALON FARMS
    MIDDLEBURY,CT06762
    KIMBERLY PEREIRA TREASURER
    1.00     		0 0 0
    2209 SCOTT ROAD
    CHESHIRE,CT06410
    EILEEN MUDRY DIRECTOR
    1.00     		0 0 0
    66 WEDGEWOOD DR
    NAUGATUCK,CT06770
    MARIE ARLENE PELLETIER DIRECTOR
    1.00     		0 0 0
    44 HIGHTOWER ROAD
    SOUTHINGTON,CT06489
    ROSEMARY TESSIER DIRECTOR
    1.00     		0 0 0
    24 DINATALI DR
    WATERBURY,CT06705
    MARY ANN DAUKAS DIRECTOR
    1.00     		0 0 0
    14 CHIPMAN STREET
    WATERBURY,CT06708
    MARY ANN CHIARELLA DIRECTOR
    1.00     		0 0 0
    48 BIRCH STREET
    WATERTOWN,CT06795
    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
    KARA VENDETTI EXECUTIVE DI
    40.00     		54,131 5,880  
    250 COLUMBIA BLVD
    WATERBURY,CT06710
    Total number of other employees paid over $50,000...................bullet  
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 HOME FOR AGED-TOTAL BED CAPACITY IS 35. 984,032
    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 N/A  
    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
    9,617,184
    b
    Average of monthly cash balances.......................
    1b
    981,574
    c
    Fair market value of all other assets (see instructions)................
    1c
    378,789
    d
    Total (add lines 1a, b, and c).........................
    1d
    10,977,547
    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
    10,977,547
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    164,663
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    10,812,884
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    540,644
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
     
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
     
    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
     
    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
    984,031
    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
    984,031
    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
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    984,031
    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  
    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......  
    b From 2011......  
    c From 2012......  
    d From 2013......  
    e From 2014......  
    fTotal of lines 3a through e........  
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 984,031
    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.....  
    e Remaining amount distributed out of corpus 984,031
    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 5 984,031
    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 ..........     		 
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		 
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2011....  
    b Excess from 2012....  
    c Excess from 2013....  
    d Excess from 2014....  
    e Excess from 2015....  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2015, enter the date of the ruling.......bullet
    1989-11-09
    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
    0       0
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		984,031 980,022 1,030,810 863,620 3,858,483
    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 ....     		984,031 980,022 1,030,810 863,620 3,858,483
    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...     		360,429 356,846 356,135 541,635 1,615,045
    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
    Total .................................bullet 3a  
    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
    aPROGRAM SERVICE FEES         595,218
    bMISCELLANEOUS         287
    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....     14 193,656  
    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 ............     		    14 102,457  
    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)..   296,113 595,505
    13Total. Add line 12, columns (b), (d), and (e)..................
    13891,618
    (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.)
    1A ENABLES HOME TO CARRY OUT EXEMPT PURPOSE OF PATIENT CARE.
    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
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
    OMB No. 1545-0047
    2015
    Name of the organization
    SOUTHMAYD HOME INC
     
    Employer identification number

    06-0646903
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
    Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
    Name of organization
    SOUTHMAYD HOME INC
          		Employer identification number
    06-0646903
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
     
     

    IDA HENRY TRUST  
    C/O BANK OF AMERICA
     
    WATERBURY, CT06702

    		$ 8,181


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
     
     

    HARRIET KIRK TRUST  
    C/O BANK OF AMERICA
     
    WATERBURY, CT06702

    		$ 21,298


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    3
     
     

    SARAH CHIPMAN TRUST  
    C/O BANK OF AMERICA
     
    WATERBURY, CT06702

    		$ 12,331


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 3
    Name of organization
    SOUTHMAYD HOME INC
          		Employer identification number

    06-0646903
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 4
    Name of organization
    SOUTHMAYD HOME INC
          		Employer identification number

    06-0646903
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

    Additional Data


    Software ID:  
    Software Version:  

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

    TY 2015 DepreciationSchedule
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    PER SCHEDULE     50,600     51,070   11,727  

    TY 2015 InvestmentsCorpBondsSchedule
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Name of Bond End of Year Book Value End of Year Fair Market Value
    CORPORATE BONDS 2,426,857 2,426,857

    TY 2015 InvestmentsCorpStockSchedule
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Name of Stock End of Year Book Value End of Year Fair Market Value
    EQUITIES 6,558,702 6,558,702

    TY 2015 InvestmentsGovtObligationsSch
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    US Government Securities - End of Year Book Value:

    679,973
    US Government Securities - End of Year Fair Market Value:

    679,973
    State & Local Government Securities - End of Year Book Value:


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


     


    TY 2015 LandEtcSchedule2
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    BUILDLINGS 2,043,784 1,714,239 329,545 349,545
    LAND 20,000   20,000  


    TY 2015 OtherAssetsSchedule
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    UNEXPIRED INSURANCE 27,219 23,244 23,244


    TY 2015 OtherExpensesSchedule
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXPENSES        
    UTILITIES 59,656   13,699 45,957
    MAINTENANCE REPAIRS & SUPPLIE 103,919   23,863 80,056
    FOOD 85,963   19,740 66,223
    MISCELLANEOUS 9,304   2,136 7,168
    LICENSES & DUES 7,857   1,804 6,053
    BANK & INVESTMENT FEES 57,172 51,455 5,717  
    INSURANCE 48,090   11,043 37,047
    OFFICE SUPPLIES & PHONE 34,938   8,023 26,915
    PURCHASED SERVICES 20,639   4,739 15,900


    TY 2015 OtherIncomeSchedule2
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    PROGRAM SERVICE FEES 595,218   595,218
    MISCELLANEOUS 287   287


    TY 2015 OtherIncreasesSchedule
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Description Amount
    UNREALIZED APPRECIATION OF SECURITIES 405,207


    TY 2015 OtherProfessionalFeesSchedule
    Name:
    SOUTHMAYD HOME INC
    EIN:
    06-0646903
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL AND ACCOUNTING 9,710 3,300 2,230 4,180