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:
Latino Consultants, LLC
1107 South Fair Oaks Ave., Suite 272
South Pasadena, CA 91030
Grant Amount:
$20,000
(2) Date of Grant:
5/23/2008
(3) Purpose:
To support production and distribution of a Bi-National Health Week Guide in Spanish to
help people learn about health care options.
(4) Total Paid:
$20,000 paid on 7/16/2008
Amount of Grant Spent by Grantee:
$20,000
(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:
12/01/08
6/10/10 (FINAL)
(7) Verification
Blue Shield of California Foundation reviewed the grant report 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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