IRS Form 990-PF for 2009 - Blue Shield of California Foundation

Form 990-PF (2009)
Part XVI-A
Enter gross amounts unless otherwise indicated.
1 Program service revenue:
Unrelated business income
(a) (b)
(c)
(d)
Amount
Amount
Business
code
Excluded by section 512, 513, or 514
a
b
c
d
e
f
g Fees and contracts from government agencies ~~~
2 Membership dues and assessments ~~~~~~~~~
3 Interest on savings and temporary cash
investments ~~~~~~~~~~~~~~~~~~~~
4 Dividends and interest from securities ~~~~~~~~
5 Net rental income or (loss) from real estate:
a Debt-financed property ~~~~~~~~~~~~~
b Not 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 ~~~~~~~~~~~~~~~~~~~
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) ~~~~~~~~
13 Total. Add line 12, columns (b), (d), and (e) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
CALIFORNIA PHYSICIANS' SERVICE FDN
(DBA BLUE SHIELD OF CALIFORNIA FDN) 94-2822302
Analysis of Income-Producing Activities
Exclusion
code
14 283,894.
18 -3,976,823.
Relationship of Activities to the Accomplishment of Exempt Purposes
(e)
Related or exempt
function income
Page 12
0. -3,692,929. 0.
-3,692,929.
Line No.
<
N/A
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).
923621
02-02-10
Form 990-PF (2009)
12
09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001