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ObjectId: 201400149349100305 - Submission: 2014-01-14
TIN: 20-8604545
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
20
12
Name of the organization
PHIL AND PAT WILLIS FOUNDATION
Employer identification number
20-8604545
Organization type
(check one):
Filers of:
Section:
Form 990 or 990-EZ
501(c)( ) (enter number) organization
4947(a)(1) nonexempt charitable trust
not
treated as a private foundation
527 political organization
Form 990-PF
501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
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
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.
Special Rules
For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33
1
/3
% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of
(1)
$5,000 or
(2)
2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use
exclusively
for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use
exclusively
for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an
exclusively
religious, charitable, etc., purpose. Do not complete any of the parts unless the
General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year
.........................
$
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 Part I, line 2 of its Form 990-PF, 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. 30613X
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page
2
Name of organization
PHIL AND PAT WILLIS FOUNDATION
Employer identification number
20-8604545
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
PHIL WILLIS
2545 SPRING ARBORL RD STE 200
JACKSON
,
MI
49203
$
97,749
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
2
PATRICIAL WILLIS
400 S JACKSON RD
JACKSON
,
MI
49201
$
113,038
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page
3
Name of organization
PHIL AND PAT WILLIS FOUNDATION
Employer identification number
20-8604545
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
1
200 BAXTER INTERNATIONAL
$
14,188
2013-03-22
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
156.191 ACTIVSION BLIZZAARD
$
1,733
2012-10-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
488 INVESTMENT CO OF AMERICA
$
14,982
2012-10-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
1
300 EXPRESS SCRIPTS HLDS
$
17,379
2013-03-22
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
250 ALTRIA GROUP
$
8,380
2012-10-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
200 ORACLE CORPORATION
$
6,130
2012-10-09
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Name of organization
PHIL AND PAT WILLIS FOUNDATION
Employer identification number
20-8604545
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
1
300 INTUIT
$
19,662
2013-03-22
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
150 BAXTER INTERNATIONAL
$
9,072
2012-10-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
358.628 PEPSICO INC
$
25,502
2012-10-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
1
1810 CBIZ INC
$
11,548
2013-03-22
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
200 CITRIX SYSTEM
$
13,628
2012-10-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
322 AMRICAN MOVIL SAB
$
6,752
2013-08-09
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Name of organization
PHIL AND PAT WILLIS FOUNDATION
Employer identification number
20-8604545
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
1
200 PHILIP MORRIS INTERNATIONAL
$
18,542
2013-03-22
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
250 EUROPACIFIC GROWTH FUND
$
9,917
2012-10-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
225 GENERAL MOTORS C
$
8,104
2013-08-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
1
500 ORACLE CORPORATION
$
16,165
2013-03-22
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
200 FASTENAL CO
$
8,556
2012-10-09
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
32.16 MFC INDUSTRIAL LTD
$
282
2013-08-09
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page
4
Name of organization
PHIL AND PAT WILLIS FOUNDATION
Employer identification number
20-8604545
Part III
Exclusively
religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year.
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.)
$
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) (2012)
Additional Data
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