2016-05-04T10:21:02-05:00 2015-06-30 BDO USA LLP 100 PARK AVENUE NEW YORK NY 100175001 990PF 2014-07-01 203101239 NICK SIMONS FOUNDATION % MARINA SHMOUKLER NICK 6463620036 25 EAST 22ND STREET NEW YORK NY 10010 MARILYN SIMONS SECRETARY/TREASURER 6466540066 2016-05-02 true Paul Hammerschmidt P01384178 2128858000 2014 2016-08-17 19:52:53Z X X 63115949 X 9812641 89 89 664799 0 0 130315 199760 189376 10384 -7872 9823114 787331 237591 237591 389817 414363 197347 197347 64812 0 0 44895 109974 36292 0 97617 47642 0 0 47642 91708 23444 0 0 17044 263987 263987 357046 357046 1239039 1018658 0 1191649 3016007 1078394 0 2852137 4436181 4761898 7452188 1078394 0 7614035 2370926 0 1232495 887380 887380 120156 50207 50207 13393 13393 13393 545908 0 0 194370 75265 75265 57753945 62089704 62089704 0 0 62808 0 0 981859 60891541 63115949 63115949 356588 45477 435717 110000 18650 173012 264720 983967 420197 X 2117864 566692 57789710 62129060 59907574 62695752 60891541 63115949 59907574 2370926 4335759 66614259 3918507 62695752 PASS THROUGH FROM PARTNERSHIP K-1 P 130315 130315 false 5766042 51923115 0.11105 5170694 40296228 0.128317 5021464 25493121 0.196973 4076656 17169912 0.23743 3924982 5965184 0.657982 1.331752 0.26635 62306980 16595464 0 16595464 7614035 0 0 0 67049 67049 67049 67049 false false false false false false false true true NY true false false true false true N/A MARINA SHMOUKLER 6463620036 25 EAST 22ND STREET NEW YORK NY 10010 true false false true true false false false false false false false false false false false true false false true false false false false JAMES SIMONS 25 EAST 22ND STREET NEW YORK NY 10010 PRESIDENT 1.0 0 0 0 MARILYN SIMONS 25 EAST 22ND STREET NEW YORK NY 10010 SECRETARY & TREASURER 2.0 0 0 0 CAITLIN HEISING 25 EAST 22ND STREET NEW YORK NY 10010 TRUSTEE 0.5 0 0 0 MARK HEISING 25 EAST 22ND STREET NEW YORK NY 10010 TRUSTEE 0.5 0 0 0 AUDREY SIMONS 25 EAST 22ND STREET NEW YORK NY 10010 TRUSTEE 0.5 0 0 0 LAURA BAXTER SIMONS 25 EAST 22ND STREET NEW YORK NY 10010 TRUSTEE 0.5 0 0 0 LIZ SIMONS 25 EAST 22ND STREET NEW YORK NY 10010 TRUSTEE 0.5 0 0 0 NAT SIMONS 25 EAST 22ND STREET NEW YORK NY 10010 TRUSTEE 0.5 0 0 0 STEPHEN RUDY 25 EAST 22ND STREET NEW YORK NY 10010 GRADIAN CEO 40.0 237591 48286 0 ERICA FRENKEL 160 FIFTH AVENUE 7TH FLOOR NEW YORK NY 10010 VP BUSINESS STRATEGY 40.0 93500 17243 0 LINA SAYED 160 FIFTH AVENUE 7TH FLOOR NEW YORK NY 10010 DIR MARKET STRATEGY 40.0 80000 16123 0 ISMAEL CORDERO 160 FIFTH AVENUE 7TH FLOOR NEW YORK NY 10010 BIOMEDICAL SRVC MGR 40.0 67000 27703 0 THOMAS BAADE 160 FIFTH AVENUE 7TH FLOOR NEW YORK NY 10010 MARKET MANAGER 40.0 53115 6308 0 Speck Product Design Inc 3221 PORTER DRIVE PALO ALTO CA 94304 Product development 238835 BHEKH THAPA 239 TANKA PRASAD ROAD BANESHWOR HEIGHT KATHMANDU NP PROGRAM CONSULTANT 81000 STEPHEN KNOBLE PO BOX 8975 EPC 1813 KATHMANDU NP EPC 1813 PROGRAM CONSULTANT 80000 PAUL FENTON AGNAC FR 47800 PROGRAM CONSULTANT 79882 OES Medical Ltd ABC HOUSE COTSWOLD DENE STANDLAKE WITNEY UK OX29 7QG SERVICE RETAINER 71565 2 SEE GENERAL EXPLANATION ATTACHMENT 2493775 SEE GENERAL EXPLANATION ATTACHMENT 211500 61332250 1923567 0 63255817 0 63255817 948837 62306980 3115349 3115349 0 0 3115349 3115349 3115349 7614035 0 0 0 0 7614035 7614035 3115349 0 2012 2011 2010 0 3626723 3218164 3746956 3156293 3169886 16918022 7614035 0 3115349 4498686 21416708 0 0 0 0 3626723 17789985 3218164 3746956 3156293 3169886 4498686 JAMES SIMONS NONE X NICK SIMONS INSTITUTE BOX 8975 EPC 1813 JHAMSIKHEL BOX 8975, EPC 181 NP EPC 1813 n/a NC PROGRAM & GENERAL OPERATING SUPPORT 2146888 Prime Minister's Earthquake Disaster Relief OFFICE OF THE PRIME MINISTER Singh Durbar Kathmandu NP N/A PC EARTHQUAKE DONATION 1000000 THE AMERICAN HIMALAYAN FOUNDATION 900 MONTGOMERY STREET SUITE 400 SAN FRANCISCO CA 94133 N/A PC PROGRAM SUPPORT 323793 HIMALAYAN CATARACT PROJECT PO BOX 55 WATERBURY VT 05676 N/A PC GENERAL OPERATING SUPPORT 50000 Medecins Sans FrontiersDoctors without Border 337 7th avenue new york NY 10001 N/A PC to fund the ebola fund 250000 Patan Academy of Health Sciences P O Box 26500 Kathmandu NP N/A PC PURPOSE RESTRICTED SUPPORT 235717 FUTURE GENERATIONS HC 73 BOX 100 RT 33W NORTH MOUNTAIN FRANKLIN WV 26807 N/A PC GENERAL OPERATING SUPPORT 25000 IPAS PO Box 9990 Chapel Hill NC 27515 N/A PC GENERAL OPERATING SUPPORT 25000 United Mission to Nepal PO Box 126 Kathmandu NP N/A PC TO SUPPORT Okhaldhunga hospital 100000 FRIENDS OF PATAN HOSPITAL 1980 DAHLIA STREET DENVER CO 80220 N/A PC TO SUPPORT CHARITABLE ACTIVITIES OF PATAN HOSPITAL 5000 KATHAMANDU VALLEY PRESERVATION TRUST 136 WEST 21ST STREET 11TH FL NEW YORK NY 10011 N/A PC restoration of Patan Royal Palace and re-building fund for Kathmandu monuments and to provide expertise on earthquake resistant building. 15000 HOSPICE NEPAL LALITPUR LAGANKHEL NP N/A NC GENERAL OPERATING SUPPORT 5000 NEPAL AMBULANCE SERVICE Sitapaila KathmandU NP N/A NC GENERAL OPERATING SUPPORT 15000 LO GYALPO JIGME CC FOUNDATION PO BOX 10489 CHABAHIL KATHMANDU NP N/A NC GENERAL OPERATING SUPPORT 5000 Northern Ireland Hospice 18 ONeill Road Newtownabbey EI BT36 6WB N/A NC PROGRAM SUPPORT 80000 AMERICAN NEPAL MEDICAL FOUNDATION 2743 SOUTH VETERANS HOSPITAL PMB SPRINGFIELD IL 62704 N/A PC GENERAL OPERATING SUPPORT 27500 Autism Care Nepal 156-NEEL SARASWATI MARG, GAIRIDHARA-2 KATHMANDU NP N/A PC EARTHQUAKE RELIEF AND RECOVERY OF FAMILIES OF Autism Care Nepal community. 50000 GENERAL BOARD OF GLOBAL MINISTRIES COVENANT RELATIONSHIP OFFICE 475 RIVERSIDE DRIVE ROOM 320 NEW YORK NY 10115 N/A PC GENERAL OPERATING SUPPORT 45000 SEBS-North America 3348 Conquistador Ct ANNANDALE VA 22003 N/A PC Directed to Bloom Nepal School to rebuild the school and student residences affected by the earthquake in Nepal. 25000 Partners Asia 436 14th Street Suite 700 OAKLAND CA 94612 N/A PC GENERAL OPERATING SUPPORT 20000 Gurung Tamu Society 3224 71st Street East Elmhurst NY 11370 N/A PC for Hamro Nepal: International Benefit Concert 10000 POSSIBLE 17 WEST 17TH STREET 7TH FLOOR NEW YORK NY 10011 N/A PC GENERAL OPERATING SUPPORT 200000 PROJECT PRAKASH FOUNDATION 955 MASSACHUSETTS AVENUE 351 CAMBRIDGE MA 02139 N/A PC GENERAL OPERATING SUPPORT 100000 Nepal Ko Yuwa 35 Chestnut Street Belmont NY 02478 n/a PC to support Walk for Nepal 3000 4761898 HOSPICE NEPAL LALITPUR LAGANKHEL LAGANKHEL NP n/a NC GENERAL OPERATING SUPPORT 10000 10000 14 89 10384 89 10384 10473 10 SUBSIDIZED SALES OF UNIVERSAL ANESTHESIA MACHINES TO CHARITABLE OR NOT-FOR-PROFIT ORGANIZATIONS AS PART OF THE FOUNDATION'S MISSION TO IMPROVE HEALTHCARE IN DEVELOPING COUNTRIES. false false false false false false false false false false X X 1 JAMES SIMONS 160 FIFTH AVENUE 7TH FLOOR NEW YORK NY 10010 9737641 X 2 THE TECH MUSEUM OF INNOVATION 201 S Market Street SAN JOSE CA 95113 75000 X BDO AUDIT AND TAX - NSF 54750 18068 0 47513 BDO AUDIT AND TAX - GHS 13360 4409 8240 FMA BOOKKEEPING - GHS 41864 13815 41864 NICK SIMONS INSTITUTE BOX 8975 EPC 1813 JHAMSIKHEL LALITPUR NP 2015-06-19 2146888 TO TRAIN AND SUPPORT SKILLED COMPASSIONATE HEALTHCARE WORKERS IN THE RURAL REGIONS OF NEPAL 2146888 NO 6/30/2015 The Foundation has no reason to doubt the accuracy or reliability of the report from the grantee so no independent verification of the report was required or made. HOSPICE NEPAL 2015-06-30 5000 TO SUPPORT Hospice's important mission TO PROVIDE palliative care 5000 NO 6/30/2015 The Foundation has no reason to doubt the accuracy or reliability of the report from the grantee so no independent verification of the report was required or made. NEPAL AMBULANCE SERVICE 2015-06-19 15000 TO Support Ambulatory Care to Kathmandu and Patan 15000 NO 6/30/2015 The Foundation has no reason to doubt the accuracy or reliability of the report from the grantee so no independent verification of the report was required or made. LO GYALPO JIGME CC FOUNDATION PO BOX 10489 CHABAHIL KATHMANDU NP 2015-03-27 5000 TO SUPPORT FOUNDATION'S restoration and education PROJECT in Mustang 5000 NO 6/30/2015 The Foundation has no reason to doubt the accuracy or reliability of the report from the grantee so no independent verification of the report was required or made. NORTHERN IRELAND HOSPICE 18 ONEILL ROAD NEWTOWNABBEY EI BT36 6WB 2015-01-29 80000 TO FUND PALLIATIVE CARE FELLOWSHIP 80000 NO 6/30/2015 THE FOUNDATION HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE SO NO INDEPENDENT VERIFICATION OF THE REPORT WAS REQUIRED OR MADE. Patan Academy of Health Sciences PO Box 26500 Kathmandu NP 2015-05-22 200000 to support emergency response including surgical supplies, equip. & charitable medical srvcs. 200000 NO 6/30/2015 THE FOUNDATION HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE SO NO INDEPENDENT VERIFICATION OF THE REPORT WAS REQUIRED OR MADE. Patan Academy of Health Sciences PO Box 26500 Kathmandu NP 2015-05-22 35717 To support the Oxygen Generator Project at Patan Hospital in Kathmandu, Nepal. 35717 NO 6/30/2015 THE FOUNDATION HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE SO NO INDEPENDENT VERIFICATION OF THE REPORT WAS REQUIRED OR MADE. Autism Care Nepal 156-NEEL SARASWATI MARG GAIRIDHARA-2 KATHMANDU NP 2015-05-22 50000 To support relief and recovery for families of the Autism Care Nepal community. 50000 NO 6/30/2015 THE FOUNDATION HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE SO NO INDEPENDENT VERIFICATION OF THE REPORT WAS REQUIRED OR MADE. United Mission to Nepal PO Box 126 Kathmandu NP 2015-04-28 100000 To support renovation and expansion project of the Okhaldhunga Hospital. 100000 NO 6/30/2015 THE FOUNDATION HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE SO NO INDEPENDENT VERIFICATION OF THE REPORT WAS REQUIRED OR MADE. Prime Minister's Earthquake Disaster OFFICE OF THE PRIME MINISTER SINGH DURBAR KATHMANDU NP 2015-05-19 1000000 to alleviate the suffering of families and communities affected by the earthquake and its aftermath. 1000000 NO 6/30/2015 THE FOUNDATION HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE SO NO INDEPENDENT VERIFICATION OF THE REPORT WAS REQUIRED OR MADE. FORM 990PF, PART III, LINE 5: FORM 990PF, PART III, LINE 5: Transfer of net assets on March 30, 2015 to Gradian Health Systems, LLC (EIN 27 2092828), exempt under Internal Revenue Code ("IRC") Section 501(c)(3) and a private operating foundation under IRC Section 4942 (j)(3). Gradian received tax-exempt status pursuant to a determination letter issued by the Internal Revenue Service on May 7, 2015. CASH AND CASH EQUIVALENTS....................$2,111,263. ACCOUNTS RECEIVABLE..............................18,684. PREPAID EXPENSES AND OTHER ASSETS...............167,064. INVENTORY.....................................1,816,493. FIXED ASSETS....................................127,200. TOTAL ASSETS............................................$4,240,704. ACCOUNTS PAYABLE AND ACCRUED EXPENSES........$ 235,454. ACCRUED WARRANTY COSTS...........................50,653. DEFERRED REVENUE.................................36,090. TOTAL LIABILITIES.......................................$ 322,197. ------------ TOTAL TRANSFER OF NET ASSETS............................$3,918,507. ============ FORM 990PF, PART IX-A - Summary of Direct Charitable Activities FORM 990PF, PART IX-A - Summary of Direct Charitable Activities LINE 1: TO SUPPORT DEVELOPMENT AND TECHNOLOGY OF THE UNIVERSAL ANESTHESIA MACHINE ("UAM"), A LOW COST, TROLLEY BASED WORKSTATION PROVIDING INHALATION ANESTHESIA USING AN OXYGEN CONCENTRATOR, AND INSTALLATION OF 17 UAMS IN 17 HOSPITALS IN 7 COUNTRIES. LINE 2: PARTNERSHIP WITH 18 HOSPITALS IN NEPAL AND SUPPORT TRAINING FOR 4,090 RURAL HEALTH CARE WORKERS, CURRICULA DEVELOPMENT, TRAINING SITE START-UP AND DEVELOPMENT, AND PROGRAMS THAT HELP RETAIN HEALTH CARE WORKERS IN THE FIELD. HEDGE FUNDS FMV 62089704 62089704 LEGAL FEES - NSF 6741 6741 LEGAL FEES - GHS 58071 38154 TRANSFER OF NET ASSETS TO GRADIAN 0 HEALTH SYSTEMS, LLC, (EIN 27-2092828), 0 (SEE GENERAL EXPLANATION ATTACHMENT) 3918507 PARTNERSHIP EXP - RIEF 517826 0 PARTNERSHIP EXP - RIDA 500832 PROGRAM EXPENSES - GHS 113682 99600 DUES AND SUBSCRIPTIONS - NSF 1699 1699 DUES AND SUBSCRIPTIONS - GHS 12451 12451 OFFICE EXPENSES - NSF 3842 3842 OFFICE EXPENSES - GHS 123666 106778 INSURANCE - NSF 28175 28406 INSURANCE - GHS 26419 18195 PRODUCTION DEV. COSTS - GHS 339805 339805 WARRANTY EXPENSE - GHS 17139 8712 MARKETING EXPENSE - GHS 266615 266615 BOARD DEVELOPMENT, TECHNICAL ADVISORY AND COUNTRY REPRESENTATION SERVICES - NSF 66500 66500 HEALTH CARE WORKER DEVELOPMENT AND TRAINING - NSF 103000 103000 PAYROLL SERVICE FEES - GHS 20225 20225 VIDEO PRODUCTION - GHS 15285 15285 MISCELLANEOUS - NSF 88645 88645 MISCELLANEOUS - GHS 11891 11891 FROM PARTNERSHIP INTERESTS - RIDA -7872 NET UNREALIZED GAIN ON INVESTMENTS 4335759 DEFERRED EXCISE TAX LIABILITY 173012 264720 OTHER PROFESSIONAL FEES - GHS 47642 0 0 47642 UNIVERSAL ANAESTHESIA MACHINE 199760 199760 EXCISE TAX EXPENSE 91708 0 0 FOREIGN TAXES PAID 23444 NICK SIMONS INSTITUTE BOX 8975 EPC 1813 JHAMSIKHEL LALITPUR NP 203101239 TO TRAIN & SUPPORT HEALTHCARE WORKERS IN THE RURAL REGIONS OF NEPAL. 2146888 2146888