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
2013
Name of the organization
BLAIR FAMILY FOUNDATION INC
 
Employer identification number
94-3301545
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) (2013)
Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
BLAIR FAMILY FOUNDATION INC
  		Employer identification number

94-3301545
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
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
Parker, CO80134

$28,215


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

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
Parker, CO80134

$37,595


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

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$23,363


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

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$19,127


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
5
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$17,403


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
6
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$15,401


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Name of organization
BLAIR FAMILY FOUNDATION INC
  		Employer identification number

94-3301545
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
7
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$27,690


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
8
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$12,581


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
9
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$14,265


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
10
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$13,596


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
11
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$19,215


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
12
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$16,658


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Name of organization
BLAIR FAMILY FOUNDATION INC
  		Employer identification number

94-3301545
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
13
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$9,018


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
14
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$10,287


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
15
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$11,307


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
16
 
 

JAMES DONNA BLAIR  
7924 FOREST KEEP CIRCLE
 
PARKER, CO80134

$13,586


(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) (2013)
Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
BLAIR FAMILY FOUNDATION INC
  		Employer identification number

94-3301545
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
 1,000 SHS TATA MOTORS $28,215 2013-01-28
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
2
 1,000 SHS SEAGATE TECHNOLOGIES $37,595 2013-01-28
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
3
 2,500 SHS HEADWATER INC. $23,363 2013-07-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
4
 500 SHS TRINITY INDUSTRIES $19,127 2013-07-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
5
 250 SHS CREE INC $17,403 2013-07-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
6
 250 SHS DOMINOES PIZZA $15,401 2013-07-23
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Name of organization
BLAIR FAMILY FOUNDATION INC
  		Employer identification number

94-3301545
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
7
 1,000 SHS MORGAN STANLEY $27,690 2013-07-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
8
 200 SHS AETNA INC $12,581 2013-10-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
9
 1,000 SHS AMERICAN CAPITAL $14,265 2013-10-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
10
 214 SHS MOTOROLA $13,596 2013-10-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
11
 750 SHS DELTA AIRLINES $19,215 2013-10-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
12
 250 SHS DOMINOES PIZZA $16,658 2013-10-23
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Name of organization
BLAIR FAMILY FOUNDATION INC
  		Employer identification number

94-3301545
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
13
 400 SHS ISHARES $9,018 2013-10-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
14
 2,500 SHS SIRIUS $10,287 2013-10-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
15
 100 SHS VALEANT PHARMA $11,307 2013-10-23
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
16
 200 SHS SANDISK CORP $13,586 2013-10-23
(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) (2013)
Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
BLAIR FAMILY FOUNDATION INC
  		Employer identification number

94-3301545
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
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) (2013)

Additional Data


Software ID: 13000170
Software Version: 2013v3.1