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

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Blue Shield of California Foundation 990PF- Part XV 3a-Paid during the year California Physicians' Service Fdn (dba Blue Shield of California Fdn) FEIN: 94-2822302 Attachment A Organization Legal Name Foundation Status of Organization Payment Date Project Title Payment Amount Local Initiative Health Authority for Los Angeles County Government/tribal/public entity 05/29/09 2009 Healthy Kids Premium $2,000,000.00 Lodi Memorial Hospital Association, Inc. Non-profit, non-foundation 10/14/09 CHAIPI Phase II $10,000.00 Long Beach Network for Health Non-profit, non-foundation 01/13/09 Health Information Exchange $62,500.00 Long Beach Network for Health Non-profit, non-foundation 08/13/09 Health Information Exchange $62,500.00 Long Valley Health Center Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $40,000.00 Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Non-profit, non-foundation 10/14/09 CHAIPI Phase II $10,000.00 Los Angeles Christian Health Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $50,000.00 Lyon-Martin Health Services, Inc. Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $50,000.00 MACT Health Board, INC Non-profit, non-foundation 01/13/09 2008 Community Clinic and Consortium Core Support Initiative $40,000.00 MACT Health Board, INC Non-profit, non-foundation 10/29/09 2009 Community Clinic Initiative $40,000.00 MEND Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $50,000.00 MMC for Children & F ili Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $35,000.00 Maitri Charitable Trust Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 Marin Abused Women's Services Non-profit, non-foundation 12/18/09 Domestic Violence Advocates and Faith and Spiritual Community Leaders: Collaboratives for $68,750.00 Marin Abused Women's Services Non-profit, non-foundation 07/31/09 Domestic Violence Advocates and Faith and Spiritual Community Leaders: Collaboratives for $68,750.00 Marin Abused Women's Services Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $15,000.00 Marin Community Clinics Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $40,000.00 Marjaree Mason Center, I Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $15,000.00 Martha's Village and Kitchen, Non-profit, non-foundation 10/01/09 2009 Community Clinic Initiative $50,000.00 Mathiesen Memorial Health Clinic Government/tribal/public entity 09/18/09 2009 Community Clinic Initiative $35,000.00 Matthew J. DeLaney Scholarship recipient 12/02/09 Scholarship to California Polytechnic State $2,000.00 Matthew J. DeLaney Scholarship recipient 08/13/09 Scholarship to California Polytechnic State $2,000.00 MayView Community Health Non-profit, non-foundation 11/19/09 2009 Community Clinic Initiative $40,000.00 Page 14 of 26 January 26, 2010 Data contained in this report was filtered on Payment Date between 01/01/09 and 12/31/09, Payment Status of 'Paid'.
Blue Shield of California Foundation 990PF- Part XV 3a-Paid during the year California Physicians' Service Fdn (dba Blue Shield of California Fdn) FEIN: 94-2822302 Attachment A Organization Legal Name Foundation Status of Organization Payment Date Project Title Payment Amount Mendocino Coast Clinic, I Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $40,000.00 Mendocino Community Health Clinic, Inc. Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $40,000.00 Mercy Foundation, Bakersfield Non-profit, non-foundation 05/14/09 2009 Healthy Kids Premium $169,058.00 Mercy Foundation, Bakersfield Non-profit, non-foundation 09/18/09 Healthy Kids Program Premium Subsidy - Childrens Health Initiative for Kern $96,680.00 Miners Community Clinic, I Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $25,000.00 Mission Area Health Associates, dba Mission Neighborhood Health Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $40,000.00 Mission City Community Network, Inc. Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $30,000.00 Mission Hospital Regional Medical Center Non-profit, non-foundation 10/01/09 CHAIPI Phase II $12,500.00 Mobile Medical Office Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $35,000.00 Morongo Basin Unity Home, Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $10,000.00 Mountain Crisis Services, I Non-profit, non-foundation 08/13/09 2008 - 2010 Shelter Initiative $15,000.00 Mountain Health & Community Services, Inc. Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $40,000.00 Mountain Valleys Health Centers, Inc. Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $40,000.00 Mountain Women's Resource Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 Mountains Community Hospital Foundation Non-profit, non-foundation 09/04/09 Mountains Community Hospital Telemedicine Program $28,750.00 Mountains Community Hospital Foundation Non-profit, non-foundation 08/13/09 Mountains Community Hospital Telemedicine Program $28,750.00 My Sister's House Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 NAACP Special Contribution Non-profit, non-foundation 09/04/09 General Support to SF NAACP $10,000.00 Napa Emergency Women's Services Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $10,000.00 Narika Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 National Academy of Sciences Non-profit, non-foundation 03/26/09 Institute of Medicine (IOM) Roundtable on Evidence- Based Medicine $137,500.00 National Center on Family Homelessness Inc. Non-profit, non-foundation 12/30/09 Community Circles of Support for Veterans' Families $190,000.00 National Family Justice Center Alliance Non-profit, non-foundation 04/15/09 California Family Justice Initiative $475,200.00 National Health Services, I Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $40,000.00 Page 15 of 26 January 26, 2010 Data contained in this report was filtered on Payment Date between 01/01/09 and 12/31/09, Payment Status of 'Paid'.
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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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Form 990-PF (2009) Part X CALIFORNI
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CALIFORNIA PHYSICIANS' SERVICE FDN
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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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