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

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CALIFORNIA PHYSICIANS' SERVICE FDN (DBA 94-2822302 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 1 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} SOURCE AMOUNT }}}}}} }}}}}}}}}}}}}} INTEREST INCOME 283,894. }}}}}}}}}}}}}} TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A 283,894. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-PF LEGAL FEES STATEMENT 2 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} LEGAL TO FM 990-PF, PG 1, LN 16A 365. }}}}}}}}}}}} 365. 0. }}}}}}}}}}}} 0. 0. }}}}}}}}}}}} 0. 365. }}}}}}}}}}} 365. ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-PF ACCOUNTING FEES STATEMENT 3 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} AUDIT AND TAX SERVICES TO FORM 990-PF, PG 1, LN 16B 29,854. }}}}}}}}}}}} 29,854. 0. }}}}}}}}}}}} 0. 0. }}}}}}}}}}}} 0. 29,854. }}}}}}}}}}} 29,854. ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 4 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} INVESTMENT MANAGEMENT FEES 25,500. 25,500. 0. 0. PROGRAM CONSULTING & EVALUATION 3,393,356. }}}}}}}}}}}} TO FORM 990-PF, PG 1, LN 16C 3,418,856. 0. }}}}}}}}}}}} 25,500. 0. }}}}}}}}}}}} 0. 3,468,576. }}}}}}}}}}} 3,468,576. ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ 17 STATEMENT(S) 1, 2, 3, 4 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
CALIFORNIA PHYSICIANS' SERVICE FDN (DBA 94-2822302 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-PF TAXES STATEMENT 5 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} EXCISE TAX TO FORM 990-PF, PG 1, LN 18 46,000. }}}}}}}}}}}} 46,000. 0. }}}}}}}}}}}} 0. 0. }}}}}}}}}}}} 0. 0. }}}}}}}}}}} 0. ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-PF OTHER EXPENSES STATEMENT 6 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} STAFF TRAINING 26,202. 0. 0. 24,627. OFFICE SUPPLIES AND EXPENSES 19,722. 0. 0. 19,423. CONTRACT STAFF TO FORM 990-PF, PG 1, LN 23 190,135. }}}}}}}}}}} 236,059. 0. }}}}}}}}}}}} 0. 0. }}}}}}}}}}}} 0. 192,648. }}}}}}}}}}} 236,698. ~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FOOTNOTES STATEMENT 7 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} FORM 990-PF, PART I - CONTRIBUTIONS, GIFTS, GRANTS, ETC., RECEIVED CONTRIBUTION OF STOCK (SEE SCHEDULE C) }}}}}}}}}}}}} TOTAL 24,864,623. ~~~~~~~~~~~~~ FORM 990-PF, PART III - OTHER INCREASES AND DECREASES IN 18 STATEMENT(S) 5, 6, 7 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
Page 1 and 2: November 9, 2010 California Physici
Page 3 and 4: TAX RETURN FILING INSTRUCTIONS FORM
Page 5 and 6: Form 990-PF (2009) Assets Liabiliti
Page 7 and 8: Form 990-PF (2009) Part VI CALIFORN
Page 9 and 10: Form 990-PF (2009) Part VII-B CALIF
Page 11 and 12: Form 990-PF (2009) Part X CALIFORNI
Page 13 and 14: CALIFORNIA PHYSICIANS' SERVICE FDN
Page 15 and 16: Form 990-PF (2009) Part XVI-A Enter
Page 17 and 18: Schedule B (Form 990, 990-EZ, or 99
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California Physicians' Service Fdn
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TAX RETURN FILING INSTRUCTIONS CALI
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CALIFORNIA PHYSICIANS' SERVICE FDN
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IRS Form 990-PF for 2009 - Blue Shield of California Foundation

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