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

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Form 990-PF (2009) Part VII-B CALIFORNIA PHYSICIANS' SERVICE FDN (DBA BLUE SHIELD OF CALIFORNIA FDN) 94-2822302 Statements Regarding Activities for Which Form 4720 May Be Required (continued) 5a During the year did the foundation pay or incur any amount to: (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ~~~~~~~~~~~~~ Yes X No (2) Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly, any voter registration drive? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X No (3) Provide a grant to an individual for travel, study, or other similar purposes? ~~~~~~~~~~~~~~~~~ X Yes No (4) Provide a grant to an organization other than a charitable, etc., organization described in section 509(a)(1), (2), or (3), or section 4940(d)(2)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ X Yes No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X No b If any answer is "Yes" to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ~~~~~~~~~~~~~~~~~~~~~~~~ Organizations relying on a current notice regarding disaster assistance check here ~~~~~~~~~~~~~~~~~~~~~ | c If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax because it maintained expenditure responsibility for the grant?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SEE STATEMENT 14 X Yes No If "Yes," attach the statement required by Regulations section 53.4945-5(d). 6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X No b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ~~~~~~~~~~~~~~~~ If "Yes" to 6b, file Form 8870. 7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? ~~~~~~~~~ Yes X No b If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? N/A Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors 1 List all officers, directors, trustees, foundation managers and their compensation. (b) Title, and average (a) Name and address hours per week devoted to position (c) Compensation (d) (e) Expense (If not paid, account, other enter -0-) allowances Contributions to employee benefit plans and deferred compensation 5b 6b 7b Page 6 X X SEE STATEMENT 13 67,500. 0. 0. 2 Compensation of five highest-paid employees (other than those included on line 1). If none, enter "NONE." (b) Title, and average (a) Name and address of each employee paid more than $50,000 hours per week (c) Compensation devoted to position SEE STATEMENT 7 (d) Contributions to employee benefit plans and deferred compensation (e) Expense account, other allowances 0.00 0. 0. 0. Total number of other employees paid over $50,000 | Form (2009) 990-PF 0 923551 02-02-10 6 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
Form 990-PF (2009) 3 Five highest-paid independent contractors for professional services. If none, enter "NONE." (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation Total number of others receiving over $50,000 for professional services 1 Part VIII Part IX-A CALIFORNIA PHYSICIANS' SERVICE FDN (DBA BLUE SHIELD OF CALIFORNIA FDN) 94-2822302 Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors (continued) JEMMOTT ROLLINS GROUP - 453 SPRING ST, SUITE 1028, LOS ANGELES, CA 90013 PROGRAM CONSULTANT 364,625. FENTON COMMUNICATIONS - 182 SECOND STREET, 4TH FLOOR, SAN FRANCISCO, CA 94105 COMMUNICATIONS 333,288. UNIVERSITY OF CALIFORNIA, SAN FRANCISCO - 3333 CALIFORNIA ST., STE. 430, SAN FRANCISCO, PROGRAM CONSULTANT 322,746. PUTNAM COMMUNITY INVESTMENT CONSULTING - ONE EMBARCADERO CENTER, SUITE 500, SAN FRANCISCO, PROGRAM CONSULTANT 155,000. HEALTH MANAGEMENT ASSOCIATES - 5811 PELICAN BAY BLVD, SUITE 500, NAPLES, FL 34108 COMMUNICATIONS 121,568. 22 Summary of Direct Charitable Activities List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. SEE ATTACHMENT D 9 Expenses Page 7 2 2,316,819. 3 4 1 Part IX-B Summary of Program-Related Investments Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. N/A Amount 2 3 All other program-related investments. See instructions. Total. Add lines 1 through 3 J 990-PF 0. Form (2009) 923561 02-02-10 7 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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IRS Form 990-PF for 2009 - Blue Shield of California Foundation

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