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

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<strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> Cali<strong>for</strong>nia <strong>Foundation</strong><br />

<strong>990</strong><strong>PF</strong>- Part XV 3a-Paid during the year<br />

Cali<strong>for</strong>nia Physicians' Service Fdn<br />

(dba <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> Cali<strong>for</strong>nia Fdn)<br />

FEIN: 94-2822302<br />

Attachment A<br />

Organization Legal Name<br />

<strong>Foundation</strong> Status <strong>of</strong><br />

Organization<br />

Payment Date<br />

Project Title<br />

Payment Amount<br />

Southern Trinity Health<br />

Services, Inc.<br />

Non-pr<strong>of</strong>it, non-foundation<br />

10/01/09<br />

<strong>2009</strong> Community Clinic<br />

Initiative<br />

$35,000.00<br />

Southside Coaltion <strong>of</strong><br />

Community Health Centers<br />

Southwest Community<br />

Health Center<br />

St. Anthony <strong>Foundation</strong><br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

12/02/09<br />

09/18/09<br />

09/18/09<br />

<strong>2009</strong> Clinic Fiscal Health<br />

Initiative<br />

<strong>2009</strong> Community Clinic<br />

Initiative<br />

<strong>2009</strong> Community Clinic<br />

Initiative<br />

$57,000.00<br />

$40,000.00<br />

$50,000.00<br />

St. James Infirmary<br />

St. John's Well Child and<br />

Family Center, Inc.<br />

St. Vincent De Paul<br />

Society,<br />

Particular Council <strong>of</strong> San<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

09/18/09<br />

09/18/09<br />

07/31/09<br />

<strong>2009</strong> Community Clinic<br />

Initiative<br />

<strong>2009</strong> Community Clinic<br />

Initiative<br />

2008 - 2010 Shelter<br />

Initiative<br />

$50,000.00<br />

$40,000.00<br />

$5,000.00<br />

St. Vincent de Paul Village,<br />

Inc.<br />

Su Casa ~ Ending<br />

Domestic<br />

Support Network <strong>for</strong><br />

Battered Women<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

10/01/09<br />

08/13/09<br />

07/31/09<br />

<strong>2009</strong> Community Clinic<br />

Initiative<br />

2008 - 2010 Shelter<br />

Initiative<br />

2008 - 2010 Shelter<br />

Initiative<br />

$25,000.00<br />

$10,000.00<br />

$15,000.00<br />

Sutter Delta Medical Center<br />

Non-pr<strong>of</strong>it, non-foundation<br />

10/01/09<br />

CHAIPI Phase II<br />

$22,500.00<br />

Sutter Delta Medical Center<br />

Non-pr<strong>of</strong>it, non-foundation<br />

10/14/09<br />

CHAIPI Phase II<br />

$32,500.00<br />

Sutter Health Sacramento<br />

Sierra Region<br />

Sutter Health Sacramento<br />

Sierra Region<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

12/30/09<br />

10/01/09<br />

CHAIPI Phase II: Sutter<br />

Roseville Medical Center<br />

CHAIPI Phase II: Sutter<br />

Auburn Faith Hospital<br />

$10,000.00<br />

$10,000.00<br />

Sutter Health Sacramento<br />

Sierra Region<br />

Sutter Health Sacramento<br />

Sierra Region<br />

Sutter Solano Medical<br />

C t<br />

Swords to Plowshares<br />

Veterans Rights<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

12/30/09<br />

10/01/09<br />

12/30/09<br />

12/30/09<br />

CHAIPI Phase II: Sutter<br />

Davis Hospital<br />

CHAIPI Phase II: Sutter<br />

Medical Center,<br />

CHAIPI Phase II<br />

Veteran Family Violence:<br />

Increasing Awareness and<br />

Access to Service<br />

$10,000.00<br />

$10,000.00<br />

$10,000.00<br />

$124,927.00<br />

T.H.E. Clinic, Inc.<br />

Non-pr<strong>of</strong>it, non-foundation<br />

09/18/09<br />

<strong>2009</strong> Community Clinic<br />

Initiative<br />

$25,000.00<br />

Tahoe Women's Services<br />

Taiwan Buddhist Tzu Chi<br />

Medical <strong>Foundation</strong> USA<br />

Taproot <strong>Foundation</strong><br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

Non-pr<strong>of</strong>it, non-foundation<br />

09/04/09<br />

09/18/09<br />

09/18/09<br />

2008 - 2010 Shelter<br />

Initiative<br />

<strong>2009</strong> Community Clinic<br />

Initiative<br />

Service Grant<br />

Sponsorships<br />

<strong>for</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> Cali<strong>for</strong>nia<br />

<strong>Foundation</strong>¿s Grantees in<br />

Los Angeles and the San<br />

$5,000.00<br />

$60,000.00<br />

$60,000.00<br />

Taproot <strong>Foundation</strong><br />

Non-pr<strong>of</strong>it, non-foundation<br />

12/18/09<br />

Building the Capacity <strong>of</strong><br />

<strong>Blue</strong><br />

<strong>Shield</strong> <strong>of</strong> Cali<strong>for</strong>nia<br />

<strong>Foundation</strong>¿s Grantees:<br />

$50,000.00<br />

Tehachapi Valley<br />

Healthcare<br />

Government/tribal/public<br />

entity<br />

08/13/09<br />

Health In<strong>for</strong>mation<br />

Exchange<br />

$62,500.00<br />

Page 22 <strong>of</strong> 26<br />

January 26, 2010<br />

Data contained in this report was filtered on Payment Date between 01/01/09 and 12/31/09, Payment Status <strong>of</strong> 'Paid'.

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