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

California Physicians' Service Fdn
(dba Blue Shield of California Fdn)
FEIN: 94-2822302
Attachment E
Blue Shield of California Foundation
FEIN 94-2822302
ATTACHMENT TO 2009 FORM 990-PF
RETURN OF PRIVATE FOUNDATION
STATEMENT REQUIRED BY REG. §53.4945-5(d)
INFORMATION WITH RESPECT TO EXPENDITURE RESPONSIBILITY GRANTS
(1) Grantee:
California Children's Hospital Association
1215 K ST STE 1930
SACRAMENTO, CA 95814-3911
(2) Grant Amount:
$105,000
Date of Grant:
3/1/2008
(3) Purpose:
To support a California children's hospital quality-improvement initiative to reduce the
incidence of catheter-associated blood stream infections and other serious hospitalacquired
infections in California Children's Services (CCS) approved regional NICUs.
(4) Total Paid:
$52,500 paid on 4/11/2008
$52,500 paid on 9/16/2008
TOTAL $105,000
Amount of Grant Spent by Grantee:
$105,000
(5) Diversion:
To the knowledge of the Foundation, and based on the report furnished by the grantee,
no grant funds have been diverted from the purpose of the grant.
(6) Date of Report(s) Received from Grantee:
9/30/2008
1/30/2009
8/01/2009 (FINAL)
(7) Verification
Blue Shield of California Foundation reviewed the grant reports received but did not
undertake any verification of the grantee's reports as there has not been any reason to
doubt their accuracy or reliability (Reg. 53.4945-5(c)).
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