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

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Blue Shield of California Foundation 990PF- Part XV 3a-Paid during the year California Physicians' Service Fdn (dba Blue Shield of California Fdn) FEIN: 94-2822302 Attachment A Organization Legal Name Foundation Status of Organization Payment Date Project Title Payment Amount Katherine T. Wertzler Scholarship recipient 08/13/09 Scholarship to University of Washington $2,000.00 Katherine T. Wertzler Scholarship recipient 12/02/09 Scholarship to University of Washington $2,000.00 Katie M. Shelly Scholarship recipient 12/02/09 Scholarship to Foothill College $1,500.00 Katie M. Shelly Scholarship recipient 08/13/09 Scholarship to Foothill College $1,500.00 Kene Me-Wu Family Healing Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 Kids Come First Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $50,000.00 Kings Community Action Organization Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 Korean Community Center of Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 Korean Health Education Information and Research Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $50,000.00 LEON AND SYLVIA PANETTA INSTITUTE FOR Non-profit, non-foundation 11/19/09 General Support $20,000.00 La Casa de las Madres Non-profit, non-foundation 08/13/09 2008 - 2010 Shelter Initiative $10,000.00 La Clínica de la Raza, Inc. Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $40,000.00 La Cocina, Inc. Non-profit, non-foundation 12/30/09 General Operating Support $5,000.00 La Maestra Family Clinic, I Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $30,000.00 Laguna Beach Community Clinic Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $50,000.00 Lake Family Resource C t Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 Lassen Family Services, I Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 Laura's House Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $10,000.00 Legal Aid Foundation of Los Non-profit, non-foundation 01/13/09 Immigrant Rights for Domestic Violence Victims $30,000.00 Lestonnac Free Clinic Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $50,000.00 Liberty Hill Foundation Non-profit, non-foundation 01/30/09 Leadership Development Grant $4,000.00 Lifelong Medical Care Non-profit, non-foundation 10/01/09 2009 Community Clinic Initiative $30,000.00 Linsey T. Huffman Scholarship recipient 08/13/09 Scholarship to San Joaquin Delta College $2,000.00 Linsey T. Huffman Scholarship recipient 12/02/09 Scholarship to San Joaquin Delta College $2,000.00 Livingston Community Health Non-profit, non-foundation 02/18/09 2008 Community Clinic and Consortium Core Support Initiative $25,000.00 Livingston Community Health Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $25,000.00 Page 13 of 26 January 26, 2010 Data contained in this report was filtered on Payment Date between 01/01/09 and 12/31/09, Payment Status of 'Paid'.
Blue Shield of California Foundation 990PF- Part XV 3a-Paid during the year California Physicians' Service Fdn (dba Blue Shield of California Fdn) FEIN: 94-2822302 Attachment A Organization Legal Name Foundation Status of Organization Payment Date Project Title Payment Amount Local Initiative Health Authority for Los Angeles County Government/tribal/public entity 05/29/09 2009 Healthy Kids Premium $2,000,000.00 Lodi Memorial Hospital Association, Inc. Non-profit, non-foundation 10/14/09 CHAIPI Phase II $10,000.00 Long Beach Network for Health Non-profit, non-foundation 01/13/09 Health Information Exchange $62,500.00 Long Beach Network for Health Non-profit, non-foundation 08/13/09 Health Information Exchange $62,500.00 Long Valley Health Center Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $40,000.00 Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Non-profit, non-foundation 10/14/09 CHAIPI Phase II $10,000.00 Los Angeles Christian Health Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $50,000.00 Lyon-Martin Health Services, Inc. Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $50,000.00 MACT Health Board, INC Non-profit, non-foundation 01/13/09 2008 Community Clinic and Consortium Core Support Initiative $40,000.00 MACT Health Board, INC Non-profit, non-foundation 10/29/09 2009 Community Clinic Initiative $40,000.00 MEND Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $50,000.00 MMC for Children & F ili Non-profit, non-foundation 09/18/09 2009 Community Clinic Initiative $35,000.00 Maitri Charitable Trust Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $5,000.00 Marin Abused Women's Services Non-profit, non-foundation 12/18/09 Domestic Violence Advocates and Faith and Spiritual Community Leaders: Collaboratives for $68,750.00 Marin Abused Women's Services Non-profit, non-foundation 07/31/09 Domestic Violence Advocates and Faith and Spiritual Community Leaders: Collaboratives for $68,750.00 Marin Abused Women's Services Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $15,000.00 Marin Community Clinics Non-profit, non-foundation 09/04/09 2009 Community Clinic Initiative $40,000.00 Marjaree Mason Center, I Non-profit, non-foundation 07/31/09 2008 - 2010 Shelter Initiative $15,000.00 Martha's Village and Kitchen, Non-profit, non-foundation 10/01/09 2009 Community Clinic Initiative $50,000.00 Mathiesen Memorial Health Clinic Government/tribal/public entity 09/18/09 2009 Community Clinic Initiative $35,000.00 Matthew J. DeLaney Scholarship recipient 12/02/09 Scholarship to California Polytechnic State $2,000.00 Matthew J. DeLaney Scholarship recipient 08/13/09 Scholarship to California Polytechnic State $2,000.00 MayView Community Health Non-profit, non-foundation 11/19/09 2009 Community Clinic Initiative $40,000.00 Page 14 of 26 January 26, 2010 Data contained in this report was filtered on Payment Date between 01/01/09 and 12/31/09, Payment Status of 'Paid'.
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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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Form 990-PF (2009) Part VII-B CALIF
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Form 990-PF (2009) Part X CALIFORNI
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CALIFORNIA PHYSICIANS' SERVICE FDN
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Form 990-PF (2009) Part XVI-A Enter
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Schedule B (Form 990, 990-EZ, or 99
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Form Department of the Treasury Int
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Form 8868 (Rev. 4-2009) ¥ If you a
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Blue Shield of California Foundatio
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TAX RETURN FILING INSTRUCTIONS CALI
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IRS Form 990-PF for 2009 - Blue Shield of California Foundation

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