efile Public Visual Render
ObjectId: 201522179349100012 - Submission: 2015-08-05
TIN: 94-3301545
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.
Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
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
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, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.
Special Rules
For an organization described in section 501(c)(3) 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), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000
exclusively
for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions
exclusively
for religious, charitable, etc., purposes, but no such contributions totaled 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 totaling $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 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. 30613X
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
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
,
CO
80134
$
15,532
Person
Payroll
Noncash
(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
,
CO
80134
$
13,190
Person
Payroll
Noncash
(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
,
CO
80134
$
31,200
Person
Payroll
Noncash
(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
,
CO
80134
$
9,215
Person
Payroll
Noncash
(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
,
CO
80134
$
26,783
Person
Payroll
Noncash
(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
,
CO
80134
$
11,673
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
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
,
CO
80134
$
18,792
Person
Payroll
Noncash
(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
,
CO
80134
$
16,861
Person
Payroll
Noncash
(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
,
CO
80134
$
15,555
Person
Payroll
Noncash
(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
,
CO
80134
$
19,200
Person
Payroll
Noncash
(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
,
CO
80134
$
18,586
Person
Payroll
Noncash
(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
,
CO
80134
$
17,380
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
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
,
CO
80134
$
20,205
Person
Payroll
Noncash
(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
,
CO
80134
$
32,540
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
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
500 SHS MANITOWAC COMPANY
$
15,532
2014-03-31
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
1000 SHS HEADWATERS
$
13,190
2014-03-31
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
3
1000 SHS MORGAN STANLEY
$
31,200
2014-03-31
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
4
1000 SHS SPRINT
$
9,215
2014-03-31
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
5
200 SHS VALEANT PHARMA
$
26,783
2014-03-31
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
6
150 SHS DOMINOS PIZZA
$
11,673
2014-03-31
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
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
600 SHS BROADCOM
$
18,792
2014-03-31
(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
$
16,861
2014-11-12
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
9
1000 SHS AMERICAN CAPITAL
$
15,555
2014-11-12
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
10
2000 SHS SILICON GRAPHICS
$
19,200
2014-11-12
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
11
200 SHS SANDISK
$
18,586
2014-11-12
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
12
1000 SHS BANK OF AMERICA
$
17,380
2014-11-12
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
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
1000 SHS FIFTH THIRD BANK
$
20,205
2014-11-12
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
14
4000 SHS NOKIA
$
32,540
2014-11-12
(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) (2014)
Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page
4
Name of organization
BLAIR FAMILY FOUNDATION INC
Employer identification number
94-3301545
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.)
$
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) (2014)
Additional Data
Software ID:
14000265
Software Version:
2014v5.0