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

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Schedule B (Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Service Name of the organization Organization type(check one): Schedule of Contributors | Attach to Form 990, 990-EZ, or 990-PF. OMB No. 1545-0047 2009 Employer identification number CALIFORNIA PHYSICIANS' SERVICE FDN (DBA BLUE SHIELD OF CALIFORNIA FDN) 94-2822302 Filers of: Section: Form 990 or 990-EZ 501(c)( ) (enter number) organization Form 990-PF X 4947(a)(1) nonexempt charitable trust not treated as a private foundation 527 political organization 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 X 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, aggregate 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 aggregate 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 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). LHA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2009) 923451 02-01-10 14 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
Schedule B (Form 990, 990-EZ, or 990-PF) (2009) Page of of Part I Name of organization Employer identification number CALIFORNIA PHYSICIANS' SERVICE FDN (DBA BLUE SHIELD OF CALIFORNIA FDN) 94-2822302 1 1 Part I Contributors (see instructions) (a) No. (b) Name, address, and ZIP + 4 (c) Aggregate contributions (d) Type of contribution 1 CALIFORNIA PHYSICIANS' SERVICE Person Payroll Noncash (Complete Part II if there is a noncash contribution.) 50 BEALE STREET 24,864,623. X SAN FRANCISCO, CA 94105 $ (a) No. (b) Name, address, and ZIP + 4 (c) Aggregate 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) Aggregate 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) Aggregate 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) Aggregate 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) Aggregate contributions (d) Type of contribution 923452 02-01-10 $ Person Payroll Noncash (Complete Part II if there is a noncash contribution.) Schedule B (Form 990, 990-EZ, or 990-PF) (2009) 15 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
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November 9, 2010 California Physici
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TAX RETURN FILING INSTRUCTIONS FORM
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Form 990-PF (2009) Assets Liabiliti
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Form 990-PF (2009) Part VI CALIFORN
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Form 990-PF (2009) Part VII-B CALIF
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Schedule B (Form 990, 990-EZ, or 99
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IRS Form 990-PF for 2009 - Blue Shield of California Foundation

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