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:
Integrated Healthcare Association
344 Thomas Berkley Way, Suite 350
Oakland, CA 94612
(2) Grant Amount:
$675,000
Date of Grant:
6/1/2006
(3) Purpose:
To execute a demonstration project in the Los Angeles County area that will improve the
data, establish benchmarks, enhance collaboration, and align financial incentives among
hospitals, physician organizations, and health plans to improve quality, safety, cost,
efficiency, and access in the adoption and usage of cardiovascular and orthopedic
medical devices in California.
(4) Total Paid:
$168,750 paid on 5/31/2006
$168,750 paid on 1/16/2007
$168,750 paid on 6/14/2007
$168,750 paid on 1/15/2008
TOTAL $675,000
Amount of Grant Spent by Grantee:
$675,000
(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:
11/30/2006
5/31/2007
11/30/2007
7/1/2008
5/29/2009 (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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